title: Usefulness of the triple test score for palpable breast masses; discussion 1012-3.
abstract: OBJECTIVE
  The triple test score (TTS) is useful and accurate for evaluating palpable breast masses.
  
  
  METHODS
  Diagnostic test study.
  
  
  METHODS
  University hospital multidisciplinary breast clinic.
  
  
  METHODS
  Four hundred seventy-nine women with 484 palpable breast lesions evaluated by TTS from 1991 through July 2000.
  
  
  METHODS
  Physical examination, mammography, and fine-needle aspiration were each assigned a score of 1, 2, or 3 for benign, suspicious, or malignant results; the TTS is the sum of these scores. The TTS has a minimum score of 3 (concordant benign) and a maximum score of 9 (concordant malignant). The TTS was correlated with subsequent histopathologic analysis or follow-up.
  
  
  METHODS
  The TTS was prospectively calculated for each mass. Lesions with a TTS greater than or equal to 5 were excised for histologic confirmation, whereas lesions with scores less than or equal to 4 were either excised (n = 60) or followed clinically (n = 255).
  
  
  RESULTS
  All lesions with TTS less than or equal to 4 were benign on clinical follow-up, including 8 for which the fine-needle aspiration was the suspicious component. Of the 60 biopsied lesions, 51 were normal breast tissue, 4 showed fibrocystic change, 1 was a papilloma, and 4 were atypical hyperplasia. All lesions with a TTS greater than or equal to 6 (n = 130) were confirmed to be malignant on biopsy. Thus, a TTS less than or equal to 4 has a specificity of 100% and a TTS greater than or equal to 6 has a sensitivity of 100%. Of the 39 lesions (8%) with scores of 5, 19 (49%) were malignant, and 20 (51%) were benign.
  
  
  CONCLUSIONS
  The TTS reliably guides evaluation and treatment of palpable breast masses. Masses scoring 3 or 4 are always benign. Masses with scores greater than or equal to 6 are malignant and should be treated accordingly. Confirmatory biopsy is required only for the 8% of the masses that receive a TTS of 5.
authors.affiliation: Section of Surgical Oncology, L223A, 3181 SW Sam Jackson Park Rd, Portland, OR 97201-3098, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Morris
authors.forename: R F
authors.initials: RF
authors.lastname: Pommier
authors.forename: A
authors.initials: A
authors.lastname: Morris
authors.forename: W A
authors.initials: WA
authors.lastname: Schmidt
authors.forename: G
authors.initials: G
authors.lastname: Beagle
authors.forename: P W
authors.initials: PW
authors.lastname: Alexander
authors.forename: S
authors.initials: S
authors.lastname: Toth-Fejel
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
authors.forename: J T
authors.initials: JT
authors.lastname: Vetto
mesh_terms: D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000175:diagnosis*; D002277:Carcinoma / Q000175:diagnosis; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D012680:Sensitivity and Specificity