title: Triple test in carcinoma breast.
abstract: BACKGROUND
  The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of "TRIPLE TEST"in diagnosis of carcinoma breast in rural labour class population.
  
  
  METHODS
  The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined.
  
  
  RESULTS
  Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4(th) decade) followed by 27.5% in 51-60 years age group (5(th) decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value.
  
  
  CONCLUSIONS
  TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.
authors.affiliation: Assistant Professor, Department of Surgery, ESI PGIMSR Basaidarapur, New Delhi, India .
authors.forename: Suman
authors.initials: S
authors.lastname: Kharkwal
authors.affiliation: Senior Medical Officer, Department of Surgery, ESI PGIMSR Basaidarapur, New Delhi, India .
authors.lastname: Sameer
authors.affiliation: Senior Resident, Department of Surgery, ESI PGIMSR Basaidarapur, New Delhi, India .
authors.forename: Arindam
authors.initials: A
authors.lastname: Mukherjee
keywords: Breast lump; Carcinoma breast; Triple test