ABSTRACT
OBJECTIVES: To review the performance and utility of the International Academy of Cytology (IAC) Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytology five category stratification and evaluate the impact of rapid onsite evaluation (ROSE). METHOD: A retrospective analysis of breast FNAB cytology cases with matched histopathological results at a single institution over a 32 months period using a structured reporting system with 5 diagnostic categories ("inadequate/insufficient," "benign," "atypical," "suspicious of malignancy" and "malignant") closely paralleling the proposed IAC System. RESULTS: Of 2,696 breast FNAB cases, there were 579 with matched histopathology and 456 of these had ROSE. ROSE decreased the number in the "insufficient" category (17.1% without ROSE to 4.0% with ROSE) and increased the number in the "malignant" (17.9 to 39.0%) with a lesser impact on the "atypical," "benign" and "suspicious of malignancy" categories. The performance data showed a positive predictive value of 96.4%, negative predictive value of 97.6%, and a risk of malignancy of a FNAB categorized as "insufficient" to be 2.6%, "benign" 1.7%, "atypical" 15.7%, "suspicious of malignancy" 84.6%, and "malignant" 99.5%. CONCLUSION: Breast FNAB is an accurate test enabling effective diagnosis of breast lesions. ROSE improved the performance by decreasing the proportion of "insufficient" and "atypical" and increasing the "suspicious of malignancy" and "malignant" diagnoses and enabling immediate triage for further biopsy where necessary.
Subject(s)
Breast Neoplasms/diagnosis , Cytodiagnosis/standards , Pathology, Clinical/standards , Practice Guidelines as Topic/standards , Biopsy, Fine-Needle , Breast Neoplasms/classification , Breast Neoplasms/surgery , Female , Humans , Predictive Value of Tests , Retrospective Studies , Societies, MedicalABSTRACT
INTRODUCTION: The authors present and analyze the outcome of DIABOBHU observational study. The work was carried out in Hungarian type 2 diabetic patients whose treatment was insufficient with oral antidiabetic agents. AIM: The safety and efficacy of glargine insulin added to oral antidiabetic therapy treatment was evaluated. METHOD: Between 2008 and 2011 3955 patients were enrolled. After proper education, patients titrated the insulin dosage under self-monitoring with the help of their attending physicians. During the 26-week study period 3 visits were included. The primary endpoint was the change of HbA1c. The secondary endpoints were fasting glucose levels, dose of insulin, body weight and body mass index, satisfaction of the patients with the treatment and the incidence of hypoglycemic events. RESULTS: During the study mean HbA1c decreased from 8.94% to 7.31%. Most patients achieved the glycemic goals with very low frequency of hypoglycemia. The patients did not gain weight and were satisfied with their treatment. CONCLUSIONS: The authors emphasize that this treatment based on an analogue basal insulin should be considered as an effective and safe therapy.
