Evaluation of Efficacy of IAC Yokahama Reporting System For Breast Cytology – A Single Institutional Experience.

Purpose: Breast fine needle aspiration cytology (FNAC) has a long history of providing accurate, rapid and cost-effective diagnosis of palpable breast lesions. Recently, International Academy of Cytology (IAC) at Yokohama proposed a new reporting system for breast cytology, in order to bring uniformity across the globe. Any new classification system needs to be validated for its practical applicability. Objectives: This study was conducted to categorize the breast lesions as per this classification and further determine the diagnostic efficacy and risk of malignancy in each category. Material and methods: This was a cross sectional observational analytical study. All the cases presenting to cytology OPD from Janurary 2020 upto December 2022, (N=296) with breast lesions for FNAC were included in the study. All the cases were divided into five categories as per the newly proposed IAC Yokohama reporting system. The risk of malignancy for each category was determined and diagnostic efficacy was evaluated.Results:The sample were distributed as follows: insufficient material 4.39%, benign 66.21%, atypical 10.47%, suspicious for malignancy 1.35% and malignancy 17.56%. Histopathology was obtained in 88 cases, out of which 82 (93.18%) showed concordant diagnosis. The sensitivity and specificity were 85.71% and 98.11% respectively. Risk of malignancy (ROM) in each category was as follows-benign (0.01%), atypia (71.4%), suspicious (100%) and malignancy (96.66%) respectively.Conclusion:The high efficacy of FNAC obtained in the present study, when IAC Yokohama reporting system was applied, confirms the usefulness of this scheme in reporting breast lesions. A risk-based stratification is essential in the present era to guide and alert the clinician about the subsequent management plan and the ROM.

The Role of Tumour Budding as a Prognostic Factor in Primary Invasive Ductal Carcinoma of Breast.

Background: Tumor budding is considered as an essential step in invasion and as a poor prognostic factor in carcinoma.It is used as the main prognostic factor in colon cancer but it is now gaining popularity in other tumor types. Objectives of the study was to determine tumor budding and categorize it into low grade and high grade in primary invasive breast cancer patients and to determine the association of tumor budding with clinicopathological characteristics. An attempt was also made to compare cytokeratin expression in intra- tumoral and budding sites. Method: It was an observational-analytical study including 50 cases of surgically resected modified radical mastectomy specimens diagnosed as invasive breast carcinoma in the tertiary care hospital from October 2018 to March 2020. Tumor buds were counted in H&E and IHC stained sections in 10 high power fields. IHC marker used was pan cytokeratin. Cases were classified into low tumor budding and high tumor budding. Correlation of tumor budding was done with all the established clinicopathological characteristics. Cytokeratin expression was compared in tumor proper and budding sites. Results: Among the 50 casesof invasive breast carcinoma, 24 cases showed high tumor budding (>4/10HPF) and 26 cases showed low tumor budding (?4/10HPF). High tumor budding was seen with larger size of the tumor, higher primary tumor staging, higher lymph node staging, presence of lymphovascular invasion, lymph node involvement and presence of necrosis with a significant correlation. Also cytokeratin expression was similar in tumor proper and budding sites in 92% of the cases. Interpretation & Conclusion: Tumor budding showed significant correlation with tumor size, primary tumor staging, lymph node staging, lymph node involvement, lymphovascular invasion and tumor necrosis. Thus it can be considered as a significant prognostic factor in the invasive breast carcinoma and can be incorporated in the reporting protocol for breast cancer.

Prognostic Significance of Lymphatic Vessel Density by D2-40 Immune Marker and Mast Cell Density in Invasive Breast Cancer: A Cross Sectional Study at Tertiary Care Hospital in South India.

Background: Tumour induced lymphangiogenesis plays a crucial role in metastasis and tumour progression. The intratumoural and peritumoral lymphatics are supposed to have different biological effects. The aim of present study was to investigate the correlation of intratumoral lymphatic vessel density (I LVD), peritumoral lymphatic vessel density (P LVD), intratumoral mast cell density (I MCD) and peritumoral mast cell density (P MCD) with prognostic parameters in primary breast carcinoma. Methods: Lymphangiogenesis was detected using D2-40 monoclonal antibody and mast cell by using toludine blue stain in 50 cases of primary breast carcinoma. Positively stained lymphatic vessels were counted at 40 x in dense lymphatic vascular foci (hot-spot) within the tumour. Chi square, ANOVA test and Pearsons correlation was applied to determine the relationship amongst various variables, with statistical significance set at p <0.05. Results: Mean P LVD was significantly higher than I LVD (6.25±21 vs 2.75±2.27,p <0.005). Significant correlation was noted between I LVD and P LVD and age, tumour laterality, tumour size and overall staging. However, there was no correlation between I LVD and P LVD with other important clinicopathologic prognostic markers like grade, lymphnode status and lymphovascular invasion. MCD was higher in both intratumoral and peritumoral location as compared to normal tissue. There was an association noted between P MCD with pathological staging and perineural invasion. However, there was no significant association of I MCD and P MCD with other prognostic markers like grade and lymphnode status. No significant correlation was noted between I LVD, P LVD, I MCD and P MCD. Conclusion: The evidences from our study support the utility of D2-40 stain in determining the lymphatic density in IBC. The study findings also establish the existence of lymphangiogenesis in both intratumoral and peritumoral location. For now, the data presented herein do not permit us to promote the utility of LVD and MCD as predictors of prognosis in invasive breast carcinoma.

Primary follicular lymphoma of disguised as multiple miliary like lesions: A case report and review of literature

Primary follicular lymphoma (PFL) of gastrointestinal tract (GIT) is rare and account for 1%–3% of non-Hodgkin lymphoma. Within the small intestine, the PFL is more common in jejunum than in the ileum. Due to low prevalence of the disease, the clinical manifestations are not well known, and diagnosis is usually delayed leading to complications. We herein report a case of PFL of GIT who presented with intestinal obstruction and unique gross morphology. Diagnosis was made by morphology and supported by immunohistochemistry.