Evaluation of modified triple test (clinical breast examination, ultrasonography, and fine-needle aspiration cytology) in the diagnosis of palpable breast lumps

Abstract

Objective: To find out the accuracy of the modified triple test in the diagnosis of palpable breast lumps. Materials and Methods: This was a cross-sectional study involving 50 female patients with palpable breast lumps attending the Surgical Out Patient Department of the Regional Institute of Medical Sciences, Imphal between October 2011 and September 2013, who underwent clinical breast examination (CBE), ultrasonography (USG), and fine-needle aspiration cytology (FNAC). All the cases irrespective of results underwent either excisional and or incisional biopsy for confirmation. The final histopathological report was considered the reference standard. Results: A total of 50 patients were included. The age range was 18-56 years. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CBE were 66.6%, 100%, 100%, 90%, and 91.6% respectively; those of USG 91.6%, 100%, 100%, 97.3%, and 97.9% respectively; and those of FNAC 91.6%, 100%, 100%, 97.4%, and 98% respectively. Out of 50 patients, the three tests concurred in 42 (35 benign and 7 malignant) cases. When all the three tests concurred, there were no false positive or false negative cases, and sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were all 100%. Conclusion: The triple test is valid and reliable, with a high degree of accuracy for the diagnosis of breast lumps. Of all the three components of the triple test, FNAC is the most accurate. A patient with a concordant benign triple test report can be safely followed up without the need for biopsy.