title: Accurate evaluation of palpable breast masses by the triple test score.
abstract: 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.
  
  
  METHODS
  Diagnostic test study.
  
  
  METHODS
  University hospital multidisciplinary breast clinic.
  
  
  METHODS
  Two hundred fifty-nine patients with 261 palpable breast masses studied between 1991 and 1997.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, Portland, USA.
authors.forename: A
authors.initials: A
authors.lastname: Morris
authors.forename: R F
authors.initials: RF
authors.lastname: Pommier
authors.forename: W A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: R L
authors.initials: RL
authors.lastname: Shih
authors.forename: P W
authors.initials: PW
authors.lastname: Alexander
authors.forename: J T
authors.initials: JT
authors.lastname: Vetto
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010173:Palpation; D010808:Physical Examination; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity