Stratification of breast lesions for appropriate management is achieved through an integration of clinical examination, imaging, and fine needle aspiration biopsy (FNAB). The current study aimed to evaluate the combined effectiveness of Breast Imaging- Reporting and Data System (BI-RADS); a widely used system with the International Academy of Cytology (IAC) Yokohama System for Reporting Breast FNAB Cytopathology; a recently proposed system.

A retrospective analysis was done on all breast FNABs from 2016 through 2020. The cases were categorised according to the IAC Yokohama system. Histopathological correlation of BI-RADS and IAC Yokohama system was performed. Risk of malignancy (ROM) for each category of BI-RADS and IAC Yokohama system were calculated.

The ROM for categories I to V was 38%, 0.6%, 21.9%, 100% and 97% respectively. The sensitivity, specificity, PPV, NPV, and accuracy of FNAB in scenario 1 (category III as malignant) were 98.9%, 85%, 76.1%, 99.3%, and 89.5% respectively. The sensitivity, specificity, PPV, NPV, and accuracy of FNAB in scenario 2 (category III as benign) were 90.8%, 98.9%, 97.5%, 95.7%, and 96.2% respectively. The sensitivity, specificity, PPV, NPV and accuracy of BI-RADS were 91.5%, 81.9%, 72%, 95% and 85.1%.

FNAB is still an indispensable test in the evaluation of breast lesions. The utilization of IAC- Yokohama reporting system for breast cytology in conjunction with ACR BI-RADS aids in a better stratification of lesions.