Analysis of morphologic patterns of fine-needle aspiration of the breast to reduce false-negative results in breast cytology
| Autor: | Marzia Matucci, Cristina Maddau, Paolo Bulgaresi, Guido Miccinesi, Tiziana Rubeca, Laura Galanti, Lucia Bonardi, Massimo Confortini, Stefano Ciatto, Patricia Turco, Maria Paola Cariaggi, Maria Francesca Carozzi |
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| Rok vydání: | 2005 |
| Předmět: |
Cancer Research
medicine.medical_specialty Pathology Concordance Cytodiagnosis Biopsy Fine-Needle Breast Neoplasms Risk Assessment Sensitivity and Specificity Specimen Handling Cohort Studies Diagnosis Differential Breast Diseases Cytology medicine Carcinoma Confidence Intervals Odds Ratio Humans False Negative Reactions Neoplasm Staging Observer Variation medicine.diagnostic_test business.industry Cancer Odds ratio medicine.disease Immunohistochemistry Confidence interval Fine-needle aspiration Oncology ROC Curve Multivariate Analysis Female Radiology Breast carcinoma business |
| Zdroj: | Cancer. 105(3) |
| ISSN: | 0008-543X |
| Popis: | BACKGROUND The identification of specific morphologic diagnostic criteria is of paramount importance to optimize the accuracy of fine-needle aspiration cytology (FNAC) and to reduce the rate of false-negative results. In the current study, the authors reviewed a consecutive series of false-negative findings observed in the study center to define the presence and degree of cytologic abnormalities. False-negative cases were randomly mixed with true-negative cases and were reviewed by a panel of expert readers in a blinded fashion. The main objective of the current study was to identify a morphologic pattern that may permit the reduction of false-negative findings while maintaining the specificity of FNAC. METHODS A blind review of a set of 41 consecutive false-negative and 49 true-negative breast aspiration samples was performed by a panel of 10 expert cytologists who were asked to give a final report and to classify the samples according to classic morphologic parameters. RESULTS The majority final report sensitivity was 54% (range, 19–61%) and specificity was 73% (range, 65–92%). The average concordance with the majority report, adjusted for chance agreement (κ statistic), was moderate at 0.54 (range, 0.40–0.65). Enlarged nuclear size, a hyperchromatic nucleus, the absence of naked nuclei, and the absence of apocrine metaplasia were reported more frequently in carcinoma cases, although not to a significant extent. The only variable found to be associated significantly (P = 0.041) with a diagnosis of carcinoma was the presence of microcalcifications, which nevertheless were found to occur in only a minority of carcinoma cases (7 of 41 cases) or controls (2 of 49 controls). Multivariate analysis demonstrated that the presence of microcalcifications (odds ration [OR] of 3.0; 95% confidence interval [95% CI], 1.2–7.4), the absence of naked nuclei (OR of 2.4; 95% CI, 1.3–4.4), and enlargement of the nucleus (OR of 1.9; 95% CI, 1.1–3.4) were all independently associated with false-negative findings. Diagnostic accuracy using a morphology-based score did not appear to improve the results substantially compared with the final report (sensitivity of 0.46 vs. 0.54 [P = 0.508] and a specificity of 0.80 vs. 0.73 [P = 0.218]). CONCLUSIONS The results of the current study confirm that breast FNAC false-negative results are at least partially the result of underreporting of abnormalities that may be noted at review. Detailed analysis of a single morphologic characteristic was found to be of limited diagnostic value, suggesting that operators do perceive abnormalities but cannot translate these findings into distinct morphologic categories. Cancer (Cancer Cytopathol) 2005. © 2005 American Cancer Society. |
| Databáze: | OpenAIRE |
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