title: Triple assessment in the diagnosis of breast cancer in Kashmir.
abstract: BACKGROUND
  Although the diagnosis of breast cancer is suggested on clinical examination, the degree of suspicion is variable. Currently a combination of three tests, i.e. clinical examination, radiological imaging (mammography, ultrasonography) and pathology called as triple assessment test is used to accurately diagnose all palpable breast lumps. Together they give sensitivity of 99%. The triple assessment is taken as positive if any of the three components is positive and negative only if all of its components are negative for malignancy.
  
  
  METHODS
  This study was conducted in the Department of Surgery, Government Medical College, Srinagar, Kashmir over a period of 3 years from June 2005 to May 2008. A total of 200 patients with a breast lump were selected irrespective of age. A detailed history, focused clinical examination, radiological imaging and fine-needle aspiration cytology (FNAC) were used as diagnostic tools for screening of the patients. The aim of this study was to evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma.
  
  
  RESULTS
  The sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 99.3%, respectively. The concordance for the triple assessment was 99.3%, positive predictive value was 93.3%, negative predictive value was 100%, sensitivity was 100% and specificity was 99.3%. p value was significant (0.000).
  
  
  CONCLUSIONS
  We conclude that triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and to detect patients with breast cancers with an overall accuracy of 99.3%.
authors.affiliation: Department of General Surgery, Government Medical College, Srinagar, Kashmir India.
authors.forename: Masooda
authors.initials: M
authors.lastname: Jan
authors.forename: Javeed Ahmad
authors.initials: JA
authors.lastname: Mattoo
authors.forename: Nazir Ahmad
authors.initials: NA
authors.lastname: Salroo
authors.forename: Shahnawaz
authors.initials: S
authors.lastname: Ahangar
keywords: Carcinoma; Clinical examination; Fine-needle aspiration cytology; Mammography; Ultrasonography