Objective
To study the accuracy and cost of diagnosing palpable breast lesions in younger patients using a modified triple test (MTT: physical examination, ultrasonography instead of mammography, and fine-needle aspiration).
Design
Diagnostic test study and cost-effectiveness estimate.
Setting
Multidisciplinary university breast clinic.
Patients
Fifty-five women below the recommended age of screening mammography (mean age, 33 years) with unilateral, palpable breast lesions.
Intervention
Each lesion was tested by all 3 elements of MTT, and each element was interpreted as benign, suspicious, or malignant.
Main Outcome Measures
Patients with MTTs in which all elements were concordant (in agreement) and benign were evaluated clinically (mean follow-up, 11 months). Patients in whom the results of fine-needle aspiration were scored as suspicious or malignant underwent open confirmatory biopsy.
Results
Forty-eight patients had concordant benign MTTs, including 14 patients with breast cysts. No cancers developed at the index sites during follow-up, including 5 biopsies done at the patients' request (negative predictive value and specificity, 100%). Fine-needle aspiration and physical examination were more accurate than ultrasonography in the 7 cases in which MTT was nonconcordant. Compared with the criterion standard (physical examination and open biopsy), use of MTT under the conditions of this study could avoid open biopsies in almost all cases, with average savings in charges of up to $623 per case.
Conclusion
Use of MTT for the diagnosis of unilateral, palpable breast lesions in younger women yields high diagnostic accuracy without the need for routine open biopsy, resulting in an overall reduction in patient charges.
Arch Surg. 1996;131:967-974
