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Arden Morris, MD; Rodney F. Pommier, MD; Waldemar A. Schmidt, MD; Richard L. Shih; Priscilla W. Alexander, MD; John T. Vetto, MD

Arch Surg. 1998;133:930-934.

Background  We previously reported that the triple test (physical examination, mammography, and fine needle aspiration) for palpable breast masses yields 100% diagnostic accuracy when all 3 components are concordant (all benign or all malignant). However, 40% of cases are nonconcordant and require open biopsy.

Objective  To evaluate our experience with the triple test to develop a method to further limit the need for surgical biopsy.

Design  Diagnostic test study.

Setting  University hospital multidisciplinary breast clinic.

Patients  Two hundred fifty-nine patients with 261 palpable breast masses studied between 1991 and 1997.

Intervention  The triple test was prospectively applied to each breast mass. Each component of the triple test was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total triple test score (TTS).

Main Outcome Measures  The TTS was correlated with subsequent histopathologic examination results.

Results  Eighty-eight masses had a TTS of more than 6 points; all had malignant histopathologic characteristics. One hundred fifty-two masses had a TTS of 4 points or lower; all were benign. In both groups, diagnostic accuracy and predictive value were 100%, with P <.001. Twenty-one masses had a TTS of 5 points; of these, 13 (62%) were benign and 8 (38%) were malignant.

Conclusions  The TTS reliably guides evaluation and treatment of palpable breast masses. Masses that score 6 points or higher are malignant and should undergo definitive therapy; masses that score 4 points or lower are benign and may be clinically followed up. Only those masses that score 5 points (8% of our database) require open biopsy.

From the Departments of Surgery (Drs Morris, Pommier, and Vetto), Pathology (Dr Schmidt), and Radiology (Dr Alexander and Mr Shih), Oregon Health Sciences University, Portland.

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