Evaluation of Triple Assessment Modalities in the Management of Palpable Breast Lumps
Iraqi Postgraduate Medical Journal,
2010, Volume 9, Issue 1, Pages 48-56
Breast masses are common clinical presentation in breast clinics, their managements require an efficient and accurate evaluation, using the least invasive, most accurate methods that cause minimal patients discomfort and limit any unnecessary procedure.
This study is designed to evaluate the diagnostic accuracy of triple assessment (a combination of clinical examination, imaging studies and tissue sampling) in the preoperative assessment and optimal management of palpable breast masses.
PATIENTS AND METHODS:
This clinical prospective study which was conducted in mosul breast center, department of surgery, al-jamhoory teaching hospital, mosul medical city, from november 2007 to november 2008 included 60 female patients with palpable breast masses, their age ranging between (20-76) years, were assessed prospectively using triple assessment modalities and the results of each modality were classified as benign, suspicious or malignant and compared with the confirmatory histopathological examination of the tissue specimens obtained from all patients under study via an appropriate surgical procedure. the data was collected, classified and analyzed.
The results triple test (TT) was concordant (elements had either all benign or all malignant) in 31 cases (52٪) with diagnostic accuracy reaching (100٪). Again the TT achieved (100٪) diagnostic accuracy when all elements were either malignant or suspicious which appeared in 12 of 29 nonconcordant cases (20٪ of all cases). FNAC was the most reliable element of TT in cases where the elements of TT weren't concordant (NPV 94.5٪, sensitivity 92٪ and accuracy 96.7٪).
The TT has proved to be accurate, reliable diagnostic approach for evaluation of breast masses, achieved (100٪) accuracy rate when all elements were concordant or when all elements were either suspicious or malignant, with the end result was neither missed cancer nor false positive malignant diagnosis, as the error or limitation of one modality was compensated by the other elements.
Any positive result of fnac should be taken seriously with negative results not exclude malignancy while the negative or positive results of imaging studies and examination not necessarily reflect the actual pathology should be supported by tissue diagnosis.
Patients in whom the TT elements were all benign can be safely observed, while patients in whom all the elements were malignant or suspicious, the diagnosis was certain enough to proceed with definite treatment without delay.
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