Modified triple assessment in the diagnosis of breast lump in Saurashtra region of Gujarat


  • Pradipkumar V. Solanki Department of Surgery, P.D.U. Medical College and Hospital, Rajkot, Gujarat, India
  • Iliyas A. Juneja Department of Surgery, P.D.U. Medical College and Hospital, Rajkot, Gujarat, India
  • Nileshbhai D. Chaudhari Department of Surgery, P.D.U. Medical College and Hospital, Rajkot, Gujarat, India



Modified triple assessment, Clinical examination, Mammography, Ultrasonography, Fine-needle aspiration


Background: Breast lump is a common complaint of women presenting to surgeons. Most of them are benign, careful evaluation, exact diagnosis and definitive treatment is mandatory to rule out cancer. The diagnosis of breast cancer is suggested on clinical examination. 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 100%. The triple assessment is taken as positive if any of the three components, two are positive or positive report of FNAC and negative only if all of its components are negative for malignancy.

Methods: This study was conducted in the Department of Surgery, P.D.U Medical College, Rajkot, Gujarat over a period of 2 years. A total of 100 patients with a breast lump were selected more than 15 years of age. A detailed history, focused clinical examination, radiological imaging and FNAC were used as diagnostic tools for screening of the patients. The aim of this study was to evaluate accuracy of modified triple assessment in the preoperative diagnosis of patients with breast carcinoma.

Results: Results shows sensitivity and specificity of all the modalities used in triple assessment when combined together was 100% and 99.3%, respectively. Positive predictive value was 93.3%, negative predictive value was 100%, p-value was highly significant (p<0.0001). We conclude that modified triple assessment is a very useful diagnostic tool to evaluate patients with breast lumps and an overall accuracy of 98%.

Conclusions: Thus, triple assessment is an easily available, cost effective, least invasive, rapid and patient compliant diagnostic tool for diagnosis of breast lump.


Chandak NS, Dhande R. Evaluation of Breast Masses by Sonomammography and X-ray Mammography in Correlation with Histopathological Findings. Int J Recent Surg Med Sci. 2017;3(1):3-6.

Khoda L. Evaluation of modified triple test in the diagnosis of palpable breast lumps. Journal of Medical Society. 2015;29(1):27-30.

Yang WT, Mok CO, King W, Tang, Metreweli C. Role of high frequency ultrasonography in the evaluation of palpable breast masses in Chinese women: Alternative to mammography. J Ultrasound Med. 1996;15(9):637-644.

Bhavinder A. Evaluation of a Modified Triple Test for diagnosis of breast lumps, International Journal of Enhanced Research in Medicines & Dental Care. 2015;2(12).

Shetty MK, Shah YP, Sharman RS. Prospective evaluation of the value of combined mammographic and Sonographic assessment in patients with palpable abnormalities. J Ultrasound Med. 2003;22(3):263-268.

Mohammed AZ, Edino ST, Ochicha O, Alhassan SU. Value of fine needle aspiration biopsy in preoperative diagnosis of palpable breast lumps. Ann Afric Medi. 2005;4(1):19-222.

Ronak Chaudhari. Diagnostic Approach to Palpable Breast Lump- A Quadruple Assessment. International Journal of Science and Research. 2017;6(5):2455-0450.

Kaufman Z, Shpitz B, Shapiro M, Rona R, Lew S, Dinbar A. Triple approach in the diagnosis of dominant breast masses: Combined physical examination, mammography, and fine-needle aspiration. J Surg Oncol. 1994;56(4):254-25.

Ahmed I, Nazir R, Chaudhary MY, Kundi S. Triple assessment of breast lumps. J Coll Physicians Surg Pak. 17(9):535-538.

Lingaraju N. Evaluation of Palpable Breast Lumps under the Age of 35 Years with Triple Assessment. International Journal of Scientific Study. 2016;4(1):10-15.






Original Research Articles