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A Modified Triple Test for Palpable Breast Masses: The Value of Ultrasound and Core Needle Biopsy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The original triple test score (TTS)—clinical examination, mammogram, and fine-needle aspiration (FNA) biopsy—has long been used to evaluate palpable breast masses. We modified the original TTS to include ultrasound (US) and core biopsy to determine their role in evaluating palpable breast masses.

Methods

A retrospective chart review of 320 female patients was performed. We developed a modified triple test score (mTTS) that included physical examination, mammogram and/or US, and FNA and/or core biopsy. For the examination and imaging score, 1–3 points were given for low, moderate, or high suspicion. Biopsy scores were characterized as benign, atypical, or malignant. Final outcome was determined by open biopsy or follow-up greater than 1 year.

Results

Physical examination was 92 % accurate (95 % confidence interval [CI] 0.89–0.96, p < 0.0001) at predicting whether a mass was benign or malignant. Imaging was 88 % accurate (95 % CI 0.84–0.92, p < 0.0001) and needle biopsy was 95 % accurate (95 % CI 0.92–0.98, p < 0.0001). The modified triple test was 99 % accurate (95 % CI 0.98–1.00, p < 0.0001). Each 1-point increment in the mTTS was associated with an increased risk of cancer, with an odds ratio of 9.73 (CI 5.16–18.4, p < 0.0001). For 150 patients, we compared the original TTS with the mTTS. US and core biopsy changed the scores of 24 patients; only three changed clinical management.

Conclusions

For patients with a palpable breast mass and a mTTS score of 3–4, no further assessment is necessary. Those with a mTTS of 8–9 can proceed to definitive therapy. Patients with a mTTS of 5–7 require further assessment. US and/or core biopsy added little to the accuracy or predictive value of the original TTS.

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Authors and Affiliations

  1. Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA

    Christina J. Wai MD

  2. Department of Cardiothoracic Surgery, University of California, San Francisco, CA, USA

    Ghada Al-Mubarak MD

  3. Department of Radiology, Tufts Medical Center, Boston, MA, USA

    Marc J. Homer MD

  4. Department of Radiology, St. Elizabeth’s Medical Center, Brighton, MA, USA

    Allison Goldkamp MD

  5. Breast Imaging Section, Department of Radiology, University of Chicago Medical Center, Chicago, IL, USA

    Marja Samenfeld-Specht MD

  6. Center for Gerontology and Health Research, Brown University, Providence, RI, USA

    Yoojin Lee MS, MPH

  7. Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    Tanya Logvinenko PhD

  8. Division of General Surgery and Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, MA, USA

    Janice G. Rothschild MD & Roger A. Graham MD

Authors
  1. Christina J. Wai MD
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  2. Ghada Al-Mubarak MD
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  3. Marc J. Homer MD
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  4. Allison Goldkamp MD
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  5. Marja Samenfeld-Specht MD
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  6. Yoojin Lee MS, MPH
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  7. Tanya Logvinenko PhD
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  8. Janice G. Rothschild MD
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  9. Roger A. Graham MD
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Corresponding author

Correspondence to Christina J. Wai MD.

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Wai, C.J., Al-Mubarak, G., Homer, M.J. et al. A Modified Triple Test for Palpable Breast Masses: The Value of Ultrasound and Core Needle Biopsy. Ann Surg Oncol 20, 850–855 (2013). https://doi.org/10.1245/s10434-012-2710-y

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  • DOI: https://doi.org/10.1245/s10434-012-2710-y

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