Accuracy of triple assessment as a clinical tool in detection of carcinoma breast

Akshdeep ., Amritpal Singh Bhatia, Manjit Singh Uppal


Background: One of the commonest clinical presentation of breast diseases is a lump. A definite diagnosis of any breast lump is very important to decide the course of treatment. The study evaluated that how effectively “triple assessment” helps in diagnosing carcinoma breast.  

Methods: The present study is a diagnostic study which was conducted on 50 patients. Each patient underwent a detailed history, CBE, mammography and FNAC. In this study the results of each examination were divided into three groups: benign, suspicious and malignant. The final result was compared with the HPE findings and diagnostic accuracy of triple assessment was assessed.

Results: Total 86% of cases were found to be malignant on triple assessment and 14% cases were found out to be malignant later on histopathology. Among the malignant lesions, infiltrating ductal carcinoma had the lead 96%, followed by lobular carcinoma 1 case. Sensitivity, specificity, PPV, NPV for clinical breast examination was 97%, 100%, 66%, 100%. Sensitivity, specificity, PPV and NPV for imaging was 88.89%, 100%, 100%, 88.46%. Sensitivity, specificity, PPV for FNAC was found to be 87.76%, 100%, 100%.

Conclusions: The TT was concordant in 43 cases (86%). Sensitivity of triple assessment was 95%, specificity was 100% and negative predictive value to be 100%. The TT was concordant in 43 cases (86%). In rest of the 7 lesion which were non-concordant 6 were suspicious of malignancy and 1 was probably benign entity which were later on proven to be malignant lesions by histopathology. Sensitivity of triple assessment was 95%, specificity was 100% and negative predictive value to be 100%.


Breast lump, Triple assessment, FNAC, Mammography

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DeSantis C, Siegel R, Jemal A. Breast cancer facts and figures 2013-2014. Am Canc Soc. 2013:1-38.

Kolb TM, Lichy J, Newhouse JH. Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations. Radiology. 2002;225:165–75.

Daly C, Puckett Y. Approach New Breast Mass. StatPearls. 2020.

Steinberg JL, Trudeau ME, Ryder DE, Fishell E, Chapman JA, McCready DR, et al. Combined fine-needle aspiration, physical examination and mammography in the diagnosis of palpable breast masses: their relation to outcome for women with primary breast cancer. Can J Surg. 1996;39:302–11.

Nigam M, Nigam B. Triple assessment of breast- gold standard in mass screening for breast cancer diagnosis. losr-Jdms. 2013;7(3):1-7.

Khokher S, Qureshi MU, Riaz M, Akhtar N, Saleem A. Clinicopathologic Profile of Breast Cancer Patients in Pakistan: Ten Years Data of a Local Cancer Hospital. Asian Pacific J Cancer Prev. 2013;13:693-9.

Sulhyan KR, Anvikar AR, Mujawar IM, Tiwari H. Histopathological study of breast lesions. Int J Med Res Rev. 2017;5(01):32-41.

Ravi C, Rodrigues G. Accuracy of clinical examination of breast lumps in detecting malignancy: a retrospective study. Ind J Surg Oncol. 2012;3(2):154-7.

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

Ariga R, Bloom K, Reddy VB, Kluskens L, Francescatti D, Dowlat K, et al. Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation. Am J Surg. 2002;184:410–3.

Jan M, Mattoo JA, Salroo NA, Ahangar S. Triple assessment in the diagnosis of breast cancer in Kashmir. Ind J Surg. 2010;72(2):97-103.