Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective

John Vetto, Rodney Pommier, Waldemar A. Schmidt, Heidi Eppich, Priscilla W. Alexander

    Research output: Contribution to journalArticle

    39 Citations (Scopus)

    Abstract

    Objective: To study the accuracy and cost of diagnosing palpable breast lesions in younger patients using a modified triple test (MTT: physical examination, ultrasonography instead of mammography, and fine-needle aspiration). Design: Diagnostic test study and cost-effectiveness estimate. Setting: Multidisciplinary university breast clinic. Patients: Fifty-five women below the recommended age of screening mammography (mean age, 33 years) with unilateral, palpable breast lesions. Intervention: Each lesion was tested by all 3 elements of MTT, and each element was interpreted as benign, suspicious, or malignant. Main Outcome Measures: Patients with MTTs in which all elements were concordant (in agreement) and benign were evaluated clinically (mean follow-up, 11 months). Patients in whom the results of fine- needle aspiration were scored as suspicious or malignant underwent open confirmatory biopsy. Results: Forty-eight patients had concordant benign MTTs, including 14 patients with breast cysts. No cancers developed at the index sites during follow-up, including 5 biopsies done at the patients' request (negative predictive value and specificity, 100%). Fine-needle aspiration and physical examination were more accurate than ultrasonography in the 7 cases in which MTT was nonconcordant. Compared with the criterion standard (physical examination and open biopsy), use of MTT under the conditions of this study could avoid open biopsies in almost all cases, with average savings in charges of up to $623 per case. Conclusion: Use of MTT for the diagnosis of unilateral, palpable breast lesions in younger women yields high diagnostic accuracy without the need for routine open biopsy, resulting in an overall reduction in patient charges.

    Original languageEnglish (US)
    Pages (from-to)967-974
    Number of pages8
    JournalArchives of Surgery
    Volume131
    Issue number9
    StatePublished - Sep 1996

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    Breast
    Costs and Cost Analysis
    Biopsy
    Fine Needle Biopsy
    Physical Examination
    Mammography
    Ultrasonography
    Breast Cyst
    Routine Diagnostic Tests
    Cost-Benefit Analysis
    Outcome Assessment (Health Care)
    Neoplasms

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective. / Vetto, John; Pommier, Rodney; Schmidt, Waldemar A.; Eppich, Heidi; Alexander, Priscilla W.

    In: Archives of Surgery, Vol. 131, No. 9, 09.1996, p. 967-974.

    Research output: Contribution to journalArticle

    Vetto, John ; Pommier, Rodney ; Schmidt, Waldemar A. ; Eppich, Heidi ; Alexander, Priscilla W. / Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective. In: Archives of Surgery. 1996 ; Vol. 131, No. 9. pp. 967-974.
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