Triple assessment is not necessary in most young women referred with breast symptoms.
BACKGROUND
A palpable lesion in the breast is usually subjected to triple assessment (clinical examination [CE], imaging and core biopsy [CB] or fine needle aspiration [FNA]) to minimise the risk of missing breast cancer. However, breast cancer is rare in young women, and triple assessment (especially CB) is invasive and expensive. Our aim was to see whether CB/FNA could be avoided in young women with benign findings on CE and imaging.


METHODS
This study analysed data from a prospectively entered database on female patients aged under 25 years who attended a rapid diagnosis breast clinic over a 68-month period.


RESULTS
Among 10,301 patients seen, 955 females (9.3%) were aged <25 years. The most common presenting complaint was a lump, followed by pain and nipple discharge. CE was normal or revealed benign findings in all except 15 patients, in whom it was indeterminate. Ultrasonography was performed in 692 patients (72%) and was normal (n=289) or benign (n=382) in all except 21 patients, in whom it was indeterminate. In six patients, both were indeterminate. A total of 317 patients (35%) had triple assessment: FNA in 106, CB in 239 and both in 9 cases. No cancers were diagnosed.


CONCLUSIONS
It would appear safe to omit FNA/CB in patients aged under 25 years when clinical and ultrasonography findings are normal or benign. This approach would have avoided needle biopsies in all but 30 patients (3%) in the study.
Luton and Dunstable University Hospital NHS Foundation Trust, UK.
D
D
Yue
Luton and Dunstable University Hospital NHS Foundation Trust, UK.
C
C
Swinson
Luton and Dunstable University Hospital NHS Foundation Trust, UK.
D
D
Ravichandran
D000293:Adolescent; D000367:Age Factors; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data; D001707:Biopsy, Needle / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D004739:England; D005260:Female; D006801:Humans; D010173:Palpation; D010808:Physical Examination; D014463:Ultrasonography; D019564:Unnecessary Procedures; D055815:Young Adult
Breast disease; Fine needle biopsy; Large core needle biopsy; Neoplasm