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Category: Volume 06 Issue 12 December 2018
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Title: Diagnostic Approach to Palpable Breast Lump by Modified Triple Test Score- A Prospective Study

Authors: Dr Monali Mahadev Patil, Dr P.D. Gurav, Dr Mohd Hamid Shafique Ahmed Khan

 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.178

Abstract

Introduction: Breast carcinoma is one of the common causes of cancer related deaths in women and along with colorectal and lung cancers is responsible for approximately 40% of cancer related deaths in women. The single most important prognostic factor in determining the outcome of treatment in these patients is the stage in which it is detected. The early detection of carcinoma breast is associated with excellent prognostic outcome. Triple test consisting of physical examination; mammogram and fine needle aspiration cytology is one of the most sensitive test for early detection of carcinoma breast and is found to have a considerably high sensitivity in detection of carcinoma breast as compared to any single test such as mammography or fine needle aspiration cytology. The modified triple test which substitutes mammography by ultrasound examination is also found to be highly sensitive in early detection of breast carcinoma we conducted this study to assess the accuracy of modified triple test score i.e. clinical examination, ultrasonography and fine needle aspiration cytology in breast lump by comparing with histopathology.

Materials and Methods: 50 women with palpable breast lump attending surgical outpatient and inpatient who underwent surgery for the same were included in the study on the basis of a predefined inclusion and exclusion criteria. Clinical examination of all the patients in respect to size of breast lump, site, consistency, tenderness, mobility and fixity to underlying structures was assessed in all the cases. Ultrasonography of both breast and axillae and Fine needle aspiration cytology of breast lump was done in all the cases. The accuracy of modified triple test was assessed by comparing the histopathology of the breast lump. SSPE 16.0 software was used for statistical analysis and p value less than ‘0.05’ was taken as statistically significant.

Results: Out of 50 studied cases 15 turned out to be malignant on histopathology, 14 patients had intra ductal carcinoma (no special type) and 1 had mucinous carcinoma. 35 were benign lesions on histopathology, 26 had fibro adenoma, 5 had fibrocystic disease and 2 had mammary hamartoma. Out of 50 patients, 34 had MTTS score of 3 or 4 points all of which were proved benign on histopathology report.15 patients had MTTS score of 6 and above and all were malignant on HPR, out of which 14 were intraductal carcinoma. Only 1 patient had a score of 5 and it was proved to be benign.

Conclusion: Modified triple test score assessment is highly sensitive and specific in diagnosing breast lumps as well as differentiating benign from malignant breast pathologies.

Keywords: Modified Triple Test, Clinical Examination, Fine Needle Aspiration Cytology, Ultrasonography.

References

  1. Morrow M, Wong S, Venta L: The evaluation of breast masses in women younger than forty years of age.Surgery 124(4): 634-40; discussion 640-1, 1998.
  2. Beyer T, Moonka R: Normal mammography and ultrasonography in the setting of palpable breast cancer. Am J Surg 185(5): 416-9, 2003.
  3. Donegan WL: Evaluation of a palpable breast mass. N Engl J Med 24; 327(13): 937-42, 1992.
  4. Klein S: Evaluation of palpable breast masses. Am Fam Physician 1; 71(9): 1731-8, 2005.
  5. Schuhmann R, Hubner F, Brose C, Eckel S, Geier G, Kraus H, Schondorf H, Schondorf NK: The value of aspiration cytology within the scope of triple diagnosis of palpable breast changes (Geburtshilfe Frauenheilkd). 55(10): 553-8, 1995.
  6. Vetto JT, Petty JK, Dunn N, Prouser NC, Austin DF: Structure clinical breast examination (CBE) training results in objective improvement in CBE skills. J Cancer Educ 17(3): 124-7, 2002.
  7. Morris KT, Pommier RF, Morris A, Schmidt WA, Beagle G, Alexander PW, Toth Fejel S, Schmidt J, Vetto JT: Usefulness of the triple test score for palpable breast masses. Arch Surg 136(9): 1008-12, discussion 1012-13 2001.
  8. Grobler SP, du Toit RS, Brink C, Divall PD, Middlecote BD, Nel CJ: Pre-operative evaluation of palpable breast tumours. S Afr J Surg 28(4):128-32, 1990 (Dec).
  9. Deliiski T, Baichev G, Dikov D, Todorova A, Gorchev G: The triple diagnosis of breast diseases. Akush Ginekol (Sofiia) 37(4): 33-4, 1998.
  10. Flobbe K., Kessels AG., Severens JL., Beets GL.,de Koning HJ., Von Meyenfeld MF., Van Engelshoven JM. Costs and effects of Ultrasonogaphy in the evaluation of breast masses. Int J Technol Assess Health Care 2004 fall;20(4):440-8.
  11. Kamińska M, Ciszewski T, Łopacka-Szatan K, Miotła P, Starosławska E. Breast cancer risk factors. Prz Menopauzalny. 2015;14(3): 196-202.
  12. Sun YS, Zhao Z, Yang ZN, et al. Risk Factors and Preventions of Breast Cancer. Int J Biol Sci. 2017;13(11):1387-1397. Published 2017 Nov 1.
  13. Murthy NS, Agarwal UK, Chaudhry K, Saxena S. A study on time trends in incidence of breast cancer – Indian scenario. Eur J Cancer Care. 2007;16:185–6. 7.
  14. Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS. Epidemiology and prognosis of breast cancer in young women. J Thorac Dis. 2013;5 Suppl 1(Suppl 1):S2-8.
  15. Manoharan N, Nair O, Shukla NK, Rath GK. Descriptive Epidemiology of Female Breast Cancer in Delhi, India. Asian Pac J Cancer Prev. 2017;18(4):1015-1018.
  16. Cheung KL, Lam TP. Approach to a lump in the breast: a regional perspective. Asian J Surg. 2005 Jan;28(1):65-70.
  17. Ronak Chaudhari , Samir Ray , Ashar Shaikh, Diagnostic Approach to Palpable Breast Lump - A Quadruple Assessment International Journal of Science and Research, Volume 6 Issue 5, May 2017 2572-2587.
  18. Kachewar SS, Dongre SD. Role of triple test score in the evaluation of palpable breast lump. Indian J Med Paediatr Oncol. 2015;36(2):123-7.
  19. Kumari N, Gupta V, Kumari R, Makhija A. Evaluation of risk of malignancy index as a diagnostic tool in cases with adnexal mass Int J Reprod Contracept Obstet Gynecol 2016;5:1857-61
  20. Jan, J.A. Mattoo N.A. Salroo S. Ahangar. Triple assessment in the diagnosis of breast cancer in Kashmir. Indian J Surg 2010;72:97-103.
  21. Khemka A, Chakravorty NS, Patel V.l. "Palpable breast lumps: Fine-needle aspiration cytology versus histopathology: A correlation of diagnostic accuracy." The Internet J Surg. 2009;18:1.
  22. Susan K. Evaluation of Palpable Breast Masses. Am Fam Physician. 2005; 38. 13. Suman K, Sameer, Arindam M.
  23. Ghafouri A, Sh. Attarian,    Tavangar,  N.  Sedighi: Modified Triple Test Score (Mtts) For Evaluation Ofpalpable Breast Masses In Women Under Age 40.Mjiri; 2006:20(3):115-118.
  24. Mansoor I: Analysis of inconclusive breast FNA by triple test. J Pak Med Assoc 52(1): 25-9, 2002.
  25. Wai CJ, Al-Mubarak G, Homer MJ, Goldkamp A, Samenfeld-Specht M, Lee Y, Logvinenko T, Rothschild JG, Graham RA. A modified triple test for palpable breast masses: the value of ultrasound and core needle biopsy. Ann Surg Oncol. 2013 Mar;20 (3):850-5.

Corresponding Author

Dr P.D. Gurav

Professor and Head of the Department, Department of General Surgery Government Medical College

Miraj- Maharashtra (India)