title: A modified triple test for palpable breast masses: the value of ultrasound and core needle biopsy.
abstract: BACKGROUND
  The original triple test score (TTS)--clinical examination, mammogram, and fine-needle aspiration (FNA) biopsy--has long been used to evaluate palpable breast masses. We modified the original TTS to include ultrasound (US) and core biopsy to determine their role in evaluating palpable breast masses.
  
  
  METHODS
  A retrospective chart review of 320 female patients was performed. We developed a modified triple test score (mTTS) that included physical examination, mammogram and/or US, and FNA and/or core biopsy. For the examination and imaging score, 1-3 points were given for low, moderate, or high suspicion. Biopsy scores were characterized as benign, atypical, or malignant. Final outcome was determined by open biopsy or follow-up greater than 1 year.
  
  
  RESULTS
  Physical examination was 92% accurate (95% confidence interval [CI] 0.89-0.96, p < 0.0001) at predicting whether a mass was benign or malignant. Imaging was 88% accurate (95% CI 0.84-0.92, p < 0.0001) and needle biopsy was 95% accurate (95% CI 0.92-0.98, p < 0.0001). The modified triple test was 99% accurate (95% CI 0.98-1.00, p < 0.0001). Each 1-point increment in the mTTS was associated with an increased risk of cancer, with an odds ratio of 9.73 (CI 5.16-18.4, p < 0.0001). For 150 patients, we compared the original TTS with the mTTS. US and core biopsy changed the scores of 24 patients; only three changed clinical management.
  
  
  CONCLUSIONS
  For patients with a palpable breast mass and a mTTS score of 3-4, no further assessment is necessary. Those with a mTTS of 8-9 can proceed to definitive therapy. Patients with a mTTS of 5-7 require further assessment. US and/or core biopsy added little to the accuracy or predictive value of the original TTS.
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. cjw24@georgetown.edu
authors.forename: Christina J
authors.initials: CJ
authors.lastname: Wai
authors.forename: Ghada
authors.initials: G
authors.lastname: Al-Mubarak
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Homer
authors.forename: Allison
authors.initials: A
authors.lastname: Goldkamp
authors.forename: Marja
authors.initials: M
authors.lastname: Samenfeld-Specht
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.forename: Tanya
authors.initials: T
authors.lastname: Logvinenko
authors.forename: Janice G
authors.initials: JG
authors.lastname: Rothschild
authors.forename: Roger A
authors.initials: RA
authors.lastname: Graham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D010173:Palpation; D011379:Prognosis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016217:Ultrasonography, Mammary / Q000706:statistics & numerical data*; D055815:Young Adult