Risk of Malignancy in Breast FNAB Categories, Classified According to the Newly Proposed International Academy of Cytology (IAC) Yokohama System

Background

A new category system comprising five classes (C1-insufficient material, C2-benign, C3-atypical, C4-suspicious, and C5-malignant) has been proposed by the International Academy of Cytology (IAC) for fine needle aspiration biopsy cytology (FNAB) for proper diagnosis of breast cancer.

Aims and Objectives

This study is designed to categorize institutional FNAB data according to the new system and calculation of the absolute risk of malignancy (ROM), sensitivity, specificity, positive predictive values, false negative and false-positive rate.

Study Design

We conducted a retrospective cross-sectional study involving 2133 cases collected between June, 2008 and August, 2019, at Foundation University Medical College’s Department of Histopathology and the Surgery and Oncology Department at the Fauji Foundation Hospital. All cases fulfilling the inclusion and exclusion criteria were retrieved from the archives and reviewed by two expert pathologists. Matching histopathology was compared with the cytology reports for concordance or discordance of results.

Findings

We found 6.9% (n = 147) insufficient, 65.8% (n = 1403) benign, 7.2% (n = 153) atypical, 7.5% (n = 160) suspicious and 12.6% (n = 270) malignant cases. Cyto-histological correlation was found in 421 cases from the year 2014 to 2019 with 370 concordant and 51 discordant cases. The maximum number of concordant cases was 151 in the C5 category and discordant cases had a diagnosis of C3 and C4 on cytology with 16 cases in each category. The calculated values of ROM were 45.45%, 10.3%, 30.6%, 82.79% and 99.34% from C1 to C5, respectively. We calculated 83.42% absolute sensitivity and 85.24% specificity. The positive predictive value for category 3, 4 and 5 was 67.34%, 82.7% and 99.34%, respectively, while false-negative rate was 7.9% and false-positive rate was 0.66%.

Conclusion

The ROM for C1 category calculated from this study is quite high (45.45%) compared to previous studies; therefore, it is recommended to perform core needle biopsy in all these cases. The higher sensitivity and specificity of this method of diagnosing malignant lesions supports its use.

Frequency of corneal dystrophies on the basis of histopathology in surgically removed corneas

OBJECTIVE

To assess the frequency of corneal dystrophies on the basis of histopathology in surgically-removed corneas.

METHODS

The descriptive study was conducted at Foundation University Medical College, Islamabad, and Al Shifa Eye Hospital, Rawalpindi, Pakistan, from May to October 2011, and comprised post-keratoplasty corneal specimen irrespective of age and gender. The surgically-removed corneas were processed according to the standard guidelines of histopathological processing. The histopathological sections were examined for various corneal dystrophies. Data was recorded on a proforma and was analysed using SPSS 17.

RESULTS

Of the 63 patients in the study, 12(19%) were diagnosed as having corneal dystrophies. In these 12 patients, 6(50%)were diagnosed as stromal corneal dystrophies and 5(42%)had posterior corneal dystrophies, and 1(8%)had anterior corneal dystrophy.

CONCLUSIONS

Histopathological examination of corneas is a reliable method to diagnose and classify corneal dystrophies.

Are neo-Piagetian and neo-Vygotskian interpretations of potential for learning complementary?

According to Pascual-Leone, potential for learning in the neo-Piagetian framework complements the neo-Vygotskian framework for assessment of learning potential, a manifestation of the child's zone of proximal development. Data obtained in a 1998 study by Niaz and Caraucan with three groups of children (7- to 10-yr.-olds, N=94) are reinterpreted as showing the two interpretations are complementary.

Further evidence relating mental capacity, short-term storage space, and operational efficiency

According to R. Case, a subject's Total Processing Space is the sum of his Short-term Storage Space (STSS) and Operating Space (OS). Case has hypothesized a trade-off between the two, that is, an increase in operational efficiency leads to a decrease in Operating Space and consequently more Short-term Storage Space is available for information processing. To test this hypothesis 137 high school students were tested to estimate operational efficiency (assigned a time limit to finish the Figural Intersection Test), Pascual-Leone's Structural M-capacity, Ms (i.e., STSS in Case's model), and Functional M-capacity, Mf. Besides other results a significant positive correlation of .37 was obtained between operational efficiency and Ms/STSS, which suggests that subjects find it difficult to distribute attentional load from one reserve (OS) to another (STSS).

Relations among mental capacity, Short-term Storage Space, and operational efficiency

According to R. Case, a subject's Total Processing Space is the sum of his Short-term Storage Space (STSS) and Operating Space (OS). Case has hypothesized a trade-off between the two, that is, an increase in operational efficiency leads to a decrease in operating space, and consequently more short-term space is available for information processing. To test Case's hypothesis 52 freshman students were tested to estimate operational efficiency (time taken to finish the Figural Intersection Test, when administered with a time limit), Pascual-Leone's Structural M-capacity, Ms (i.e., STSS), and Functional M-capacity, Mf. A zero correlation was obtained between operational efficiency and Ms/STSS, which suggests that subjects find it difficult to distribute attentional load from one reserve (OS) to another (STSS). This study supports Pascual-Leone's construct of Ms and Mf. It is concluded that subjects with high operational efficiency seem to be operating with the field-independent cognitive style rather than using a strategy of decreasing operating space.