Modified Triple Test Score for Palpable Breast Lumps: The Utility of Breast Ultrasound and Core Needle Biopsy in Resource-Constrained Settings
Main Article Content
Abstract
Background: Triple assessment is the standard for diagnosing breast lumps, involving clinical examination, breast imaging, and tissue diagnosis. Developed by Arden Morris et al. in 1998, the Triple Test Score evaluates palpable breast masses through clinical examination, mammography, and cytology. We used a modified triple test score with clinical examination, breast ultrasound, and core needle biopsy, aiming for rapid and accurate diagnosis for effective patient management.
Aims: Compare the Modified Triple Test Score across two biopsy guidance techniques for managing palpable breast lumps at Ahmadu Bello University Teaching Hospital, Zaria.
Methods: This randomized controlled study at Ahmadu Bello University Teaching Hospital in Zaria, Nigeria, involved patients divided into Group A for palpation-guided core needle biopsy and Group B for ultrasound-guided core needle biopsy. All patients underwent surgical biopsies. True positives, defined by concordant malignant findings, were exempt from open surgical biopsy to initiate oncologic multimodal therapy, including mastectomy. Definitive mastectomy histology reports replaced surgical biopsy results, with data analyzed using SPSS version 21.
Results: Data from 80 patients were analyzed, with 40 patients in each core needle biopsy group. The ages ranged from 18 to 72, with the peak age group (20-29 years) comprising 29 patients (36.3%). The Modified Triple Test Score was calculated using clinical breast examination, ultrasound, and core needle biopsy. In the palpation-guided group, the clinical breast examination had a sensitivity of 90.0% and a specificity of 77.8%. The breast ultrasound scan had a sensitivity of 100% and a specificity of 90.9%, and the core needle biopsy showed a sensitivity of 94.7% and a specificity of 100%, achieving a combined Modified Triple Test Score of 100%. In the ultrasound-guided group, the sensitivity and specificity of the clinical breast examination were 90.5% and 100%, respectively. The breast ultrasound scan and core needle biopsy achieved 100% sensitivity and specificity, with a combined Modified Triple Test Score of 100%.
Conclusion: This study confirms the value of the modified triple test score in evaluating breast lumps, demonstrating high accuracy for both core needle biopsy techniques when combined scores are used.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
2. Batta A, Attri P.C, Jain P, Rashid Z,, Srivastava S CN. A Study of Modified Triple Test Score For Assessment of Palpable Breast Masses In Females In Western U.P. Ind J App Res. 2016;6(4):4-9.
3. Guray M, Sahin AA, Objectives L. Breast Cancer Benign Breast Diseases: Classification, Diagnosis, and Management. Published online 2006:435-449.
4. N WP, Amabra D. Benign Breast Lumps in A Tertiary Health Care Facility in. 2016;15(12):28-31. doi:10.9790/0853-1512032831
5. Forae GD, Nwachokor FN, Igbe AP, Odokuma EI, Ijomone EA. Benign Breast Diseases in Warri, Southern Nigeria: A Spectrum of Histopathological Analysis. 2014;8(1):28-31. doi:10.4103/0331-3131.141026
6. Akarolo-anthony SN, Ogundiran TO, Adebamowo CA. Emerging breast cancer epidemic : evidence from Africa. 2010;12(Suppl 4).
7. Ibrahim NA, Popoola AO, Oludara MA, Omodele FO, Fadeyibi IO. Breast Cancer among Urban Nigerian Women: Appraising Presentation and the Quality of Care. 2011;4(4):388-392.
8. Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: Sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;386(136):E359-E386. doi:10.1002/ijc.29210
9. Provencher L, Hogue JC, Desbiens C, et al. Is clinical breast examination important for breast cancer detection ? Curr Onc. 2016;23(4):332-339.
10. Chiarelli AM, Majpruz V, Brown P, Thériault M, Shumak R, Mai V. The Contribution of Clinical Breast Examination to the Accuracy of Breast Screening. 2018;101(18). doi:10.1093/jnci/djp241
11. Hooley RJ, Scoutt LM, Philpotts LE. Breast Ultrasonography : 2013;268(3).
12. Lehman CD, Lee CI, Loving VA, et al. Ultrasound for Primary Imaging Women 30 – 39 Years of Age. 2012;(November):1169-1177. doi:10.2214/AJR.12.8842
13. Liberman L. Percutaneous image-guided core breast biopsy. Radiol Clin North Am. 2002;40(3):483-500. doi:10.1016/S0033-8389(01)00011-2
14. Johnson NB, Collins LC. Update on percutaneous needle biopsy of nonmalignant breast lesions. Adv Anat Pathol. 2009;16(4):183-195. doi:10.1097/PAP.0b013e3181a9d33e
15. Hari S, Kumari S, Srivastava A, Thulkar S, Mathur S, Veedu PT. Image guided versus Palpation guided Core Needle Biopsy of Palpable Breast Masses: A prospective study. Indian J Med Res. 2016;143(5): 597-604. doi:10.4103/0971-5916.18 7108
16. Bruening W, Fontanarosa J, Tipton K, Treadwell JR, Launders J, Schoelles K. Systematic Review: Comparative Effectiveness of Core-Needle and Open Surgical Biopsy to Diagnose Breast Lesions. Ann Intern Med. 2010;152(4):238-246.
17. Vega A, Garijo F, Ortega E. Core Needle Aspiration Biopsy of Palpable Breast Masses. Published online 2009. doi:10.3109/02841869509093635
18. Rikabi A, Hussain S. Diagnostic usefulness of tru-cut biopsy in the diagnosis of breast lesions. Oman Med J. 2013;28(2):125-127. doi:10.5001/omj.2013.32
19. Neal L, Sandhu NP, Hieken TJ, et al. Diagnosis and management of benign, atypical, and indeterminate breast lesions detected on core needle biopsy. Mayo Clin Proc. 2014;89(4). doi:10.1016/j.mayocp.2014.02.004
20. Rageth CJ, O’Flynn EA, Comstock C, et al. First International Consensus Conference on Lesions of Uncertain Malignant Potential in the Breast (B3 Lesions). Breast Cancer Res Treat. 2016;159(2). doi:10.1007/s10549-016-3935-4
21. Beagle G, Alexander PW, Toth-fejel S, Schmidt J, Vetto JT. Usefulness of the Triple Test Score for Palpable Breast Masses. 2001;136.
22. Khoda L, Kapa B, Singh KG, Gojendra T, Singh LR. Evaluation of the Modified Triple Test (Clinical Breast Examination, Ultrasonography, and Fine-Needle Aspiration Cytology) in the Diagnosis of Palpable Breast Lumps. 2015;29(1):26-30. doi:10.4103/0972-4958.158927
23. Kachewar S, Dongre S. Role of Triple Test Score in the Evaluation of Palpable Breast Lump. Indian J Med Paediatr Oncol. 2015;36(2):123-127. doi:10.4103/0971-5851.158846
24. Yamane T. Statistics: An Introductory Analysis. 2nd ed. New York: Harper and Row; 1967.
25. Ajay S, Micah B. Sampling Techniques & Determination of Sample Size in Applied Statistics Research: An Overview. 2014;II(11):1-22.
26. Afolayan A, Olaoye O, Adesina M SR. Breast Cancer Trends In A Nigerian Population: An Analysis Of Cancer Registry Data. Int J Life Sci Pharm Res. 2012;2(3):29-34.
27. Larsen I, Moller B, Johannesen T, et al. Cancer in Norway 2016- Cancer Incidence, Mortality, Survival and Prevalence in Norway. Oslo Can Reg Norw. 2017;1:1-114.
28. Alteri R, Gansler T, Gaudet M, Gierach G, DeSantis C. Breast Cancer Facts and Figures. Amer Ca Soc. 2018;1:1-44.
29. McDonald S, Saslow D, Alciati MH. Performance and Reporting of Clinical Breast Examination : A Review of the Literature. CA Cancer J Clin. 2004;54(6):345-361.
30. O’Flynn EAM, Wilson ARM, Michell MJ. Image-guided breast biopsy: state-of-the-art. Clin Radiol. 2010; 65(4):259-270. doi:10.1016/j.crad.2010.01.008
31. Wai CJ, Al-Mubarak G, Homer MJ, et al. A Modified Triple Test for Palpable Breast Masses: The Value of Ultrasound and Core Needle Biopsy. Ann Surg Oncol. 2013;20(3):850-855. doi:10.1245/s10434-012-2710-y
32. Gana S., Yusufu L, Abur P., Akorede-Olarinoye S., Bello N. Comparative Accuracy and Complications of Palpation-Guided Versus Ultrasound-Guided Core Needle Biopsy of Palpable Breast Lumps in Ahmadu Bello University Teaching Hospital, Zaria. J West Afr Coll Surg. 2023;13(2):28-36. doi:10.4103/jwas.jwas
33. Pinto D, Schmitt FC. Immunohistochemistry Applied to Breast Cytological Material. Pathobiology. 2022;89(5):343-358. doi:10.1159/000522542
34. Vaithianathan R, Sundaresan V, Santhanam R. Value of Modified Triple Test in the Diagnosis of Palpable Breast Lumps. Int J Cur Res Rev. 2013;05(5):125-134.
35. Ngotho J, Githaiga J, Kaisha W. Palpable discrete breast masses in young women: Two of the components of the modified triple test may be adequate. SAJS. 2013;51(2):58-60. doi:10.7196/ SAJS.1176
36. Karim MO, Khan KA, Khan AJ, Javed A, Fazid S, Aslam MI. Triple Assessment of Breast Lump: Should We Perform Core Biopsy for Every Patient? Cureus. 2020;12(3):10-15. doi:10.7759/cureus.7479
37. Kharkwal S, Sameer A, Mukherjee A. Triple test in carcinoma breast. J Clin Diagnostic Res. 2014;8(10): NC09-NC11. doi:10.7860/JCDR/2014/9237.4971