A study on the diagnostic approach to palpable breast lump through a modified triple assessment
Abstract
Introduction: Breast cancer is the second most common malignancy among women. With this, a study was conducted to find the sensitivity, specificity, positive predictive value, negative predictive value for the modified triple test (MTT) used in the diagnosis of palpable breast lumps.
Materials and Methods: It was a cross-sectional study, conducted in the department of General surgery, Rangaraya Medical College. Female aged >30 years, complaining about breast lump were included in the study. Breast imaging techniques and cytopathological tests were used for the diagnosis of MTT. The data were analyzed using Microsoft Excel and SPSS software version 22.0. P<0.05 was considered statistically significant.
Results: A total of 65 participants were included, the mean age was 41.84+9.1 years and 62% were benign. Age-wise, more (37%) benign cases in 31–40 years group and more (14%) malignant cases in 51 – 60 years group. The left side presentation was predominant (63%). Totally 12.3% (8) women were nulliparous, out of which 2 had malignant lesions and the rest (57; 81.7%) were multiparous. Statistically, there was no significant difference (P >0.05).
Conclusion: Among the three components of this triple assessment, the cytopathological diagnosis was considered to be the most reliable component especially in doubtful cases.
Downloads
References
Sandhu DS, Sandhu S, Karwasra RK, Marwah S: Profile of breast cancer patients at a tertiary care hospital in north India. Indian J Cancer. 2010;47(1):16-22. doi: 10.4103/0019-509X.58853.
Cochrane RA, Singhal H, Monypenny IJ, Webster DJ, Lyons K, Mansel RE: Evaluation of general practitionar referral to a specialist breast clinic according to the UK national guidelines. Eur J Surg Oncol. 1997;23(3):198-201. doi: 10.1016/s0748-7983(97)92220-4.
Frykberg ER, Kirby BI. Evolution of surgical principles and techniques for the management of breast cancer. In: Kirby BI, Copeland EM. The breast –Comprehensive management of benign and malignant disease, Vol. 2, 2nd ed, Philadelphia: WB Saunders Company; 1998:766-801.
Klein S. Evaluation of a palpable breast mass. Am Fam Physician. 2005;71(9):1731-1738.
Donegan WL. Evaluation of a palpable breast mass. N Engl J Med. 1992;327(13):937-942. doi: 10.1056/NEJM199209243271307.
Johansen C. A clinical study with special reference to diagnostic procedures: Acta clin Scand. 1975;451(l):1-70. doi: 10.1007/BF01556840.
Hermansen C, Skovgaard Poulsen H, Jensen J. Diagnostic reliability of combined physical examination, mammography and fine needle puncture (triple test) in breast tumours: a prospective study, Cancer 1987;60(8):1866-1868. doi: 10.1002/1097-0142(19871015)60:8<1866::aid-cncr2820600832>3.0.co;2-z.
Vetto J. Use of the triple test for palpable breast lesion yields high diagnostic accuracy and cost savings. Am J Surg.1995;169(5):519-522. doi: 10.1016/S0002-9610(99)80209-8.
Vetto JT, Pommier RF, Schmidt WA, Eppich H, Alexander PW. Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective. Arch Surg. 1996;131(9):967-974.
Thomas JM, Fitzharris BM, Redding WH, Williams JE, Trott PA, Powles TJ, et al. Clinical examination, xeromammography, and fine-needle aspiration cytology in diagnosis of breast tumours. Bri Med J. 1978;2(6145):1139. doi: 10.1136/bmj.2.6145.1139.
Dixon JM, Anderson TJ, Lamb J, Nixon SJ, Forrest APM. Fine-needle aspiration cytology in relationship to clinical examination and mammography in the diagnosis of a solid breast mass. Br J Surg. 1984;71(8):593-596. doi: 10.1002/bjs.1800710809.
Townsend Jr C, Beauchamp R, Evers B, Mattox K. Sabiston textbook of surgery. 19th edition, Philadelphia: Elsevier Saunders;2012;826-834.
Eriko Tohno, David Ocosgrove, Jhon D S. Basic aspects and Diagnostic features on Ultrasound. Churchill Livingstone;1994;3:49-74.
Wild JJ, Neal D. Use of high-frequency ultrasonic waves for detecting changes of texture in living tissues. Lancet. 1951;24(1):655-657. doi: 10.1016/s0140-6736(51)92403-8.
Zuber M Naib. Exfoliative cytology, Boston, Little, Brown and Company. 1996;18:477-495.
Webb AJ. Early microscopy: history of fine needle aspiration (FNA) with particular reference to goitres. Cytopatology. 2001;12(1):1-7. doi: 10.1046/j.1365-2303.2001.00276.x.
Purasiri P, Abdalla M, Heys SD, Ah-See AK, McKean ME, et al. A novel diagnostic index for use in the breast clinic. J R Coll Surg Edinb. 1996;41(1):30-34.
Morris A, Pommier R F, Morris K T. Usefulness of the triple test score for palpable breast masses. Arch Surg. 1998;136(9):1008-1013. doi: 10.1001/archsurg.133.9.930.
Mande M, Gakwaya AM, Byanyima RK. The triple assessment in the preoperative evaluation of patients with breast cancer in Mulago Hospital Kampala – Uganda. East Central Afr J Surg. 2004;9(2):111-116.
Ghafouri A, Attarian SH, Tavanagar M, Sedighi N. Modified Triple test score for evaluation of palpable breast masses in women under age 40. Med Jour Islam Repub Iran. 2006;20(3):115-118.
Jan M, Mattoo JA, Salroo NA, Ahangar S. Triple assessment in the diagnosis of breast cancer in kashmir. Ind J Surg. 2010;72(2):97-103. doi: 10.1007/s12262-010-0030-7.
Manisha N, Brijender N. Triple assessment of breast – Gold standard in mass screening for breast cancer diagnosis. IOSR-JDMS. 2013;7(3):1-7.
Prajapati CL, Jegoda RKK, Patel UA, Patel J. Breast lumps in a teaching hospital: A 5 year study. Nat J Med Res. 2014;4(1):65-67.
Jaykar RD, Kasbe P, Pargaonkar RP. A study of Modified Triple test score for assessment of palpable breast masses in young females. Int J Rec Trends Sci Techno 2013;7(2):63-73. doi: 10.1245/s10434-012-2710-y.
Hatada T, Aoki I, Okada K. Usefulness of ultrasound-guided, fine-needle aspiration biopsy for palpable breast tumors. Arch Surg. 1996;131(10):1095-1098. doi: 10.1001/archsurg.1996.01430220089020.
Beenken SW. History of the therapy of breast cancer: In Copeland BA, ed. The Breast: Comprehensive Management of Benign and Malignant Disorder. Philadelphia: Saunders; 2004; 5.
Mohammed AZ, Edino ST, Ochicha O, Alhassan SU. Value of fine needle aspiration biopsy in preoperative diagnosis of palpable breast lumps in resource poor countries: A Nigerian experience. Ann Afric Med. 2005;4(1):19-22. Available at http://hdl.handle.net/1807/5042.
Yang WT, Mok CO, King W, Tang, Metreweli C. Role of high frequency ultrasonography in the evaluation of palpable breast masses in Chinese women: Alternative to mammography. J Ultrasound Med. 1996;15(9):637-644. doi: 10.7863/jum.1996.15.9.637.
Shetty MK, Shah YP, Sharman RS. Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities. J Ultrasound Med. 2003;22(3):263-268. doi: 10.7863/jum.2003.22.3.263.
Steinberg JL, Trudeau ME, Ryder DE, Fishell E, ChapmanJA, McCready DR, et al. Combined fine-needle aspiration, physical examination and mammography in the diagnosis of palpable breast masses: their relation to outcome for women with primarybreast cancer. Can J Surg. 1996;39(4):302-311.
Surati KN, Suthar KD, Parekh B, Shah JK. A study of accuracy of triple assessment as a clinical tool for the diagnosis of a palpable breast lump. Int J Med Sci Public Health. 2013;2(3):733-737. doi: 10.5455/ijmsph.2013.070520134.
Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society
This work is licensed under a Creative Commons Attribution 4.0 International License.
OAI - Open Archives Initiative
Therapoid
