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Katherine T. Morris, MD; Rodney F. Pommier, MD; Arden Morris, MD; Waldemar A. Schmidt, MD,PhD; Gregory Beagle, MD; Priscilla W. Alexander, MD; SuEllen Toth-Fejel, PhD; Josh Schmidt, BS; John T. Vetto, MD

Arch Surg. 2001;136:1008-1013.

Hypothesis  The triple test score (TTS) is useful and accurate for evaluating palpable breast masses.

Design  Diagnostic test study.

Setting  University hospital multidisciplinary breast clinic.

Patients  Four hundred seventy-nine women with 484 palpable breast lesions evaluated by TTS from 1991 through July 2000.

Main Outcome Measures  Physical examination, mammography, and fine-needle aspiration were each assigned a score of 1, 2, or 3 for benign, suspicious, or malignant results; the TTS is the sum of these scores. The TTS has a minimum score of 3 (concordant benign) and a maximum score of 9 (concordant malignant). The TTS was correlated with subsequent histopathologic analysis or follow-up.

Interventions  The TTS was prospectively calculated for each mass. Lesions with a TTS greater than or equal to 5 were excised for histologic confirmation, whereas lesions with scores less than or equal to 4 were either excised (n = 60) or followed clinically (n = 255).

Results  All lesions with TTS less than or equal to 4 were benign on clinical follow-up, including 8 for which the fine-needle aspiration was the suspicious component. Of the 60 biopsied lesions, 51 were normal breast tissue, 4 showed fibrocystic change, 1 was a papilloma, and 4 were atypical hyperplasia. All lesions with a TTS greater than or equal to 6 (n = 130) were confirmed to be malignant on biopsy. Thus, a TTS less than or equal to 4 has a specificity of 100% and a TTS greater than or equal to 6 has a sensitivity of 100%. Of the 39 lesions (8%) with scores of 5, 19 (49%) were malignant, and 20 (51%) were benign.

Conclusions  The TTS reliably guides evaluation and treatment of palpable breast masses. Masses scoring 3 or 4 are always benign. Masses with scores greater than or equal to 6 are malignant and should be treated accordingly. Confirmatory biopsy is required only for the 8% of the masses that receive a TTS of 5.

From the Departments of Surgery (Drs K. Morris, Pommier, A. Morris, Toth-Fejel, and Vetto, and Mr Schmidt), Radiology (Drs Beagle and Alexander), and Pathology (Dr Schmidt), Oregon Health Sciences University, Portland.

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