Accurate evaluation of palpable breast masses by the triple test score

Background: We previously reported that the triple test (physical examination, mammography, and fine needle aspiration) for palpable breast masses yields 100% diagnostic accuracy when all 3 components are concordant (all benign or all malignant). However, 40% of cases are nonconcordant and require open biopsy. Objective: To evaluate our experience with the triple test to develop a method to further limit the need for surgical biopsy. Design: Diagnostic test study. Setting: University hospital multidisciplinary breast clinic. Patients: Two hundred fifty-nine patients with 261 palpable breast masses studied between 1991 and 1997. Intervention: The triple test was prospectively applied to each breast mass. Each component of the triple test was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total triple test score (TTS). Main Outcome Measures: The TTs was correlated with subsequent histopathologic examination results. Results: Eighty-eight masses had a TTS of more than 6 points; all had malignant histopathologic characteristics. One hundred fifty-two masses had a TTS of 4 points or lower; all were benign. In both groups, diagnostic accuracy and predictive value were 100%, with P<.001. Twenty-one masses had a TTS of 5 points; of these, 13 (62%) were benign and 8 (38%) were malignant. Conclusions: The TTS reliably guides evaluation and treatment of palpable breast masses. Masses that score 6 points or higher are malignant and should undergo definitive therapy; masses that score 4 points or lower are benign and may be clinically followed up. Only those masses that score 5 points (8% of our database) require open biopsy.