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Paper
September 2001

Usefulness of the Triple Test Score for Palpable Breast Masses

Author Affiliations

From the Departments of Surgery (Drs K. Morris, Pommier, A. Morris, Toth-Fejel, and Vetto, and Mr Schmidt), Radiology (Drs Beagle and Alexander), and Pathology (Dr Schmidt), Oregon Health Sciences University, Portland.

Arch Surg. 2001;136(9):1008-1013. doi:10.1001/archsurg.136.9.1008
Abstract

Hypothesis  The triple test score (TTS) is useful and accurate for evaluating palpable breast masses.

Design  Diagnostic test study.

Setting  University hospital multidisciplinary breast clinic.

Patients  Four hundred seventy-nine women with 484 palpable breast lesions evaluated by TTS from 1991 through July 2000.

Main Outcome Measures  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.

Interventions  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.

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