Evaluation of Nonconcordant Triple Test That Influences on Accurate Diagnosis of Breast Mass

Kim, Sang Won; Lee, Jin Yong

Abstract

PURPOSE: "Triple tests" have been employed to provide an accurate diagnosis of breast mass. The triple test consists of TTm (physical examination, mammogram, and fine needle aspiration cytology (FNA)) and TTs (physical examination, ultrasonography, and FNA). We undertook the present study to determine the accuracy and usefulness of the triple test in case of concordant and nonconcordant elements.
METHODS
Five hundred and six patients who visited our center with palpable breast mass from January 1990 to December 1999 were subjected to all three components of the triple test. The breast masses were listed as either benign, suspicious or malignant. Results of the triple test were analyzed as concordant or nonconcordant. All patients underwent subsequent open biopsy.
RESULTS
As 278 cases of TTm and 185 cases of TTs were found to be concordant, pathologic analysis of open biopsy determined a sensitivity of 98%, and 100%, a specificity of 99%, and 99%, a positive predictive value of 98%, and 97%, negative predictive value of 99%, and 100%, and an accuracy of 99%, and 99%, respectively. FNA was the most reliable element of the triple test in cases where three elements of the test were nonconcordant. In cases where a suspicious or malignant FNA result was accompanied by a suspicious or malignant result of mammogram or ultrasonography, the FNA false positive rate was 0%. In 160 cases of nonconcordant TTm, 83 were malignant and 77 were benign. The malignant cases of nonconcordant TTm were 10 (13%) when a single test was suspicious or malignant, 32 (64%) when two tests were suspicious or malignant, and 35 (100%) when all three tests were suspicious or malignant. In 112 cases of nonconcordant TTs, 59 were malignant and 53 were benign. The malignant cases of nonconcordant TTs were 7 (11%) when a single test was suspicious or malignant, 16 (84%) when two tests were suspicious or malignant, and 30 (96%) when all three tests were suspicious or malignant.
CONCLUSION
When all three elements of the triple test are concordant, an open biopsy for confirmation of palpable breast lesions is unnecessary. Futhermore, when the elements of the triple test are nonconcordant, we recommend definitive therapy without open biopsy only in cases where suspicious or malignant FNA results are accompanied by at least one other positive result the of the triple test.