Use of the “Triple Test” for palpable breast lesions yields high diagnostic accuracy and cost savings

The “triple test” for palpable breast lesions consists of physical examination, mammography, and fine-needle aspiration. Forty-six lesions in 43 patients were subjected to all three components of the triple test, followed by confirmatory open biopsy. In all 21 cases where the triple test was concordant (elements had either all malignant or all benign results), pathologic analysis of open biopsy samples was confirmatory (predictive value and sensitivity 100%). Fine-needle aspiration was the most reliable element of the triple test in cases where the elements of the test were nonconcordant (negative predictive value and sensitivity of 95% and 96%, respectively). The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Cost analysis revealed that elimination of confirmatory open biopsy in such cases and also in cases in which the fine-needle aspiration and one other element of the test had a suspicious or malignant result, could yield an average per-case cost savings of up to $1,412 compared to triple test followed by routine confirmatory open biopsy.