The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology

Preface
Contents
Contributors
1: The International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy Cytopathology: Introduction and Overview
	Introduction
	The Role of Breast FNAB
	The Role of CNB
	FNAB Techniques
	The Breast FNAB Report
	Risk of Malignancy and Management Guidelines
	References
2: Insufficient/Inadequate
	Introduction
	Definition
	Discussion and Background
	Insufficient FNAB Rates
	Management
	Sample Reports
	References
3: Benign
	Introduction
	Definition
	Discussion and Background
	Entities that Fall into the Benign Category
	Management
	Specific Benign Lesions
		Inflammatory Changes
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria
		Cysts and Fibrocystic Changes
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria (Fig. 3.12a–c)
		Epithelial Hyperplasia
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria (Fig. 3.21a–e)
		Radial Scars/Complex Sclerosing Lesions
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria (Fig. 3.26)
		Fibroadenoma
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria (Fig. 3.27a–h)
				Differential Diagnosis
		Intraductal Papilloma
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria (Figs. 3.31a–d and 3.32a–f)
				Differential Diagnosis
	Sample Reports
	References
4: Atypical
	Introduction
	Definition
	Discussion and Background
	Management
	Specific Breast Lesions That May Be Associated with Atypical Reports
		Low-Grade and Borderline Phyllodes Tumours
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria [29–32] (Fig. 4.6a–d)
		Adenomyoepithelioma
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria [33–37] (Fig. 4.7a–f)
			Differential Diagnosis
			Ancillary Diagnostic Studies
		Fibromatosis (Extra-abdominal Desmoid Tumour)
			Clinical, Imaging and Histopathological Features
			Key Cytological Diagnostic Criteria [40, 41] (Fig 4.8a–f)
	Sample Reports
	References
5: Suspicious of Malignancy
	Introduction
	Definition
	Discussion and Background
	Management
	Specific Breast Lesions that May Be Associated with Suspicious of Malignancy Reports
		Ductal Carcinoma In Situ
		Clinical, Imaging and Histopathological Features
		Low-Grade Ductal Carcinoma In Situ
		Key Cytological Diagnostic Criteria [19, 23, 27, 28, 35, 37] (Figs. 5.2a–e, 5.3a–c, and 5.4a–h)
		Differential Diagnosis
		Distinguishing High-Grade DCIS from Invasive Carcinoma
	Sample Reports
	References
6: Malignant
	Introduction
	Definition
	Management
	Specific Breast Lesions Producing Malignant Reports
		Invasive Carcinoma of No Special Type
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria (Figs. 6.1a–i and 6.2a–h)
			Differential Diagnosis
		High Grade Ductal Carcinoma In Situ
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria: (Fig. 6.9a, b)
			Differential Diagnosis
		Invasive Lobular Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria (Fig. 6.10a–j)
			Differential Diagnosis
		Tubular Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria (Fig. 6.12a–e)
			Differential Diagnosis
		Carcinoma with Medullary Features
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria (Fig. 6.13a–c)
			Differential Diagnosis
		Mucinous Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Features (Fig. 6.14a–e)
			Differential Diagnosis
		Invasive Micropapillary Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Features (Fig. 6.15a–e)
			Differential Diagnosis
		Metaplastic Carcinomas
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria (Figs. 6.16a–d and 6.17a–e)
			Differential Diagnosis
		Secretory Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Diagnostic Cytological Criteria (Fig. 6.18a–c)
			Differential Diagnosis
		Glycogen-Rich Clear Cell Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria
			Differential Diagnosis
		Adenoid Cystic Carcinoma
			Clinical and Histopathological Features
			Imaging
			Key Cytological Diagnostic Criteria
			Differential Diagnosis
		Carcinomas with Apocrine Differentiation
			Clinical and Histopathological Features
			Key Cytological Diagnostic Features (Fig. 6.19a–c)
			Differential Diagnosis
		Carcinoma with Neuroendocrine Features
			Clinical and Histopathological Features
			Key Cytological Diagnostic Features (Fig. 6.20)
			Well Differentiated Neuroendocrine Tumors
			Poorly Differentiated (Small Cell Carcinoma)
			Differential Diagnosis
		Non-Hodgkin Lymphoma
		Angiosarcoma
			Clinical and Histopathological Features
			Key Cytological Diagnostic Criteria (Fig. 6.22a–d)
			Differential Diagnosis
		Metastases to the Breast
	Sample Reports
	References
7: An Approach to the Interpretation of Breast Fine Needle Aspiration Biopsy Cytopathology Direct Smears
	Introduction
	Specific Patterns
	Conclusion
	Reference
8: Nipple Cytopathology
	Nipple Discharge
		Introduction
		Preparation of Discharge Material
		Cytopathology of Nipple Discharge
		Management
	Paget’s Disease of the Nipple
		Introduction
		Cytological Features
		Ancillary Testing
		Management
	References
9: Role of Ancillary Tests in Breast Fine Needle Aspiration Biopsy Cytopathology
	Role of Immunocytochemistry in Breast FNAB Cytopathology
		General Overview
			Technical Aspects
				Cytological Specimens
				Fixation
				Controls
				Procedures
			Applications
				Diagnostic Applications
					Differential Diagnosis Between Benign and Malignant Epithelial Proliferative Lesions, Including Papillary Lesions
					Subtype of Malignant Lesions
					Spindle Cell Lesions
					Identification of a Primary Breast Carcinoma in the Setting of Metastatic Carcinomas
				Classification of Breast Cancer
				Prognostic/Predictive Markers
					Hormonal Receptors: Estrogen (ER) and Progesterone (PR) Receptors
					HER2 Testing
					Ki 67, Proliferation Marker
			Conclusion
	The Role of Molecular Testing, Including Fluorescent In Situ Hybridization and Multiple Parallel Sequencing in Breast FNAB Cytopathology
		General Overview
			Technical Aspects
				Cytological Specimens and Fixation Techniques
				The Molecular Techniques
			The Application of Molecular Techniques
				Predictive Markers Including ISH for HER2
				FISH for Primary Diagnosis of Special Histopathological Subtypes of Breast Cancer, Secretory and Adenoid Cystic Carcinomas
				Tracking of Tumor Evolution, Including ESR1 Status and HER2 Amplification Status
			Conclusion
	References
10: Fine Needle Aspiration Biopsy Cytopathology of the Breast Utilizing Liquid-Based Preparations
	Introduction
	General Cytomorphological Characteristics in Liquid-Based Slides
		Cellularity
		Architectural Features
		Cell Changes
		Background Elements
	Selected Breast Lesions on LBC
		Fibroadenoma [1–5]
		Lactational Change [1–3, 6]
		Papillary Lesions [1–3]
			Intraductal Papilloma
			Papillary Carcinoma
		Carcinomas
			Invasive Carcinoma of No Specific Type (NST) [1–4, 7–9]
			Tubular Carcinoma
			Mucinous Carcinoma
			Invasive Lobular Carcinoma
			Metastatic Tumors to the Breast [1–3, 11]
	References
11: Clinical Management
	Introduction
	Management Options for Each Diagnostic Category
		Category 1: Insufficient/Inadequate
			Definition
			Management
		Category 2: Benign
			Definition
			Possible Specific Cytological Diagnoses
			Management
		Category 3: Atypical
			Definition
			Lesions that Cause most Interpretative Difficulty
			Management
		Category 4: Suspicious of Malignancy
			Definition
			Lesions that Cause Most Interpretative Difficulty
			Management
		Category 5: Malignant
			Definition
			Management
	References
Index