Background:Breast diseases constitute a heterogeneous group of lesions including developmental abnormalities,inflammatory lesions, epithelial and stromal proliferations, and neoplasms. With the use of clinical examination, mammography and fine needle aspiration cytology (FNAC), the diagnosis of a benign breast disease can be accomplished without surgery in the majority of patients. Combined use of these diagnostic procedures (Triple assessment) gives nearly the same degree of accuracy as excisional biopsy in patients with palpable breast diseases. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. The Triple Test Score (TTS) was developed to help physicians interpret discordant triple test results. A three-point scale is used to score each component of the triple test (1 = benign, 2 = suspicious, 3 = malignant). A TTS of 3 or 4 is consistent with a benign lesion; a TTS of 6 or more indicates possible malignancy that may require surgical intervention. Excisional biopsy is recommended in patients with a TTS of 5 to obtain a definitive diagnosis.
Materials and methods: The study was conducted for diagnostic accuracy of triple assessment in palpable breastlump in 50 patients. The components of the Triple Assessment are: Clinical examination (C/E), Mammography/ ultrasonograph and Fine Needle Aspiration Cytology (FNAC). The diagnostic accuracy of triple asseserment was reached by comparing the results of this test with gold standard i.e. histopathological findings.
Results :The TT was concordant in 46 cases (92%). In 17 of these lesions (34%), the results of TT were interpretedas benign and subsequently were proved to be benign pathologies histologically with NPV and Specificity of 100٪.Similarly, in 29 cases (58٪) the results of all elements of TT were interpreted as malignant, which proved to be malignant lesions on histopathological examination and the sensitivity and PPV were 100 ٪ .TT elements were non concordant in 4 cases (8٪), 3 of these cases were proved to have malignant masses and the remaining 1 case was proved to be benign on subsequent histopathological examination. In all the non concordant cases, where at least one of the elements was considered benign, FNAC was the most accurate with 0 false negative and 0 false positive results.
Conclusion: The TT has proved to be accurate, reliable diagnostic approach for evaluation of breast masses, achieved(100%) accuracy rate when all elements were concordant or when all elements were either suspicious or malignant. The study shows that when TT is concordant, final treatment may be ensued without open biopsy. In non-concordantcases, FNAC stands as single most important investigation. However due to its false negative results, other components of triple test need to be employed to enhance its efficacy and diagnostic yield.
A study on diagnostic accuracy of modified triple assessment in palpable breast lumps