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Research Paper | Pathology | India | Volume 12 Issue 7, July 2023
Diagnostic Significance of "Intermediate Lesion" in Breast Cytology: Is the Risk of Malignancy Underestimated?
Sruthi Mayura | Susan Cherian [2] | Prachi Gaddam | Sruthi Mayura
Abstract: This study aims to evaluate diagnostic significance of C3 and C4 categories as per IAC Yokohama system and to assess the risk of malignancy (ROM) of these lesions with histopathological correlation. The archived Papanicolaou and Giemsa-stained smears of 400 FNAC cases of breast lump over a period of one year from June 2019 to May 2020 were retrieved. Cases were categorized as per IAC Yokohama Standardized reporting of breast fine needle aspiration cytology into 5 categories. The smears of atypical, probably benign (C3) and suspicious, favour malignancy (C4) was reviewed for detailed cytomorphological features and histopathology correlated with cytology diagnoses. Risk of malignancy (ROM) was calculated for Code 3 & 4 category. Possible causes for erroneous reports in cases of cyto-histo discrepancy and diagnostic significance of IAC Yokohama category C3 and C4 for clinical management was analysed. The ROM in Code 3 and Code 4 was 60% and 93%. The sensitivity, specificity, positive predictive value, and negative predictive value of C3 category in the diagnosis of benign lesions among intermediate cases were 40%, 92.61%, 80%, and 66.6% respectively. Similarly, sensitivity, specificity, positive predictive value, and negative predictive value of C4 category in the diagnosis of malignancy among intermediate cases were 92.3%, 40%, 66.6%, and 80% respectively. Risk of malignancy in the intermediate category is higher hence all the cases should be evaluated and managed appropriately. There are very few lesions fall under the grey zone lesions. By categorizing them it will be helpful for the cytopathologist to make right call for clinician to facilitate the triage and take early intervention on these patients.
Keywords: Grey Zone, FNAC, IAC Category, Risk of Malignancy
Edition: Volume 12 Issue 7, July 2023,
Pages: 1190 - 1195