Systematic Use of the Clinical-Mammographic-Cytologic Triplet for the Early Diagnosis of Mammary Carcinoma

Diagnostic Efficacy of Physical Examination, Mammography, Fine Needle Aspiration Cytology (Triple-Test) in Solid Breast Lumps: An Analysis of 1708 Consecutive Cases

The clinical-radiologic-cytologic triplet was used for diagnostic evaluation in 1708 women over 30 years old with a breast lump. All the lumps were subjected to surgery except for 258 cases in which clinical resolution took place within 1-2 months. Seven-hundred and ninety-three out of 1450 nodules removed were cancers. Sensitivity of the clinical, mammographic and cytologic examinations was 82%, 73% and 68%, respectively. It increased to 95% when they were as sociated. Specificity was 63%, 80% and 97%, respectively. The predictive value of positive results of the triple test was 100%. No patient with malignant cytology was subsequently shown to have benign disease. The systematic use of the triple test in solid breast lumps for the early detection of cancer is recommended as a routine procedure. However, participation of experienced radiologists and pathologists as well as physicians skilled in fine needle puncture is required.

Ultrasound guided fine-needle aspiration cytology of breast lesions

Breast biopsy consists in the collection of cells or tissue fragments from a breast lesion and their analysis by a pathologist. There are several types of breast biopsy defined on the basis of the type of needle used: fine-needle aspiration and biopsy performed with a spring-based needle. This article focuses on fine-needle aspiration performed under sonographic guidance.It is used mainly to assess cysts that appear to contain vegetations or blood or that are associated with symptoms; lesions and solid nodules that are not unequivocally benign; and axillary lymph nodes that appear suspicious on physical examination and/or sonography.In addition to distinguishing between benign and malignant lesions, ultrasound guided fine-needle aspiration also plays an important role in tumor grading and in immunocytochemical identifying specific tumor markers. This article describes the technique used and the possible causes of false negative and false positive findings. Despite its limitations, fine-needle aspiration has become a fundamental tool for the identification and preoperative management of malignant breast lesions.

Evidence relevant to the investigation of breast symptoms: the triple test

This paper reviews and summarises evidence on the investigation of breast symptoms based on triple testing. The triple test (where any component is positive) has a sensitivity of 99.6%, a specificity of 62%, a likelihood ratio of 2.62 for a positive result, and a likelihood ratio of 0.006 for a negative result. We present measures of test accuracy for the components of the triple test that allow easy estimation of the probability of breast cancer in symptomatic women, given any possible combination of results.

Performance of Fineneedle Aspiration Cytology of the Breast. Clinical Experience in Ravenna (Italy)

Aims and background

Fineneedle aspiration cytology (FNAC) is a routine test in the evaluation of breast lesions. We assessed the diagnostic accuracy of mammography (MG), physical examination (PE), ultrasonography (US) and FNAC in 1064 histologically confirmed breast lesions (638 malignant, 426 benign) observed consecutively at the Cancer Prevention Center of Ravenna (Italy).

Methods

The performance of each test and the additional contribution of FNAC were determined.

Results

FNAC was done in 69.6 % of cancers and 39.7 % of benign lesions (P = 0.00000), the frequency of aspiration being significantly associated with severity at MG, PE, and US. For FNAC, the true positive rate was 95.1 % and the true negative rate 67.4 %. Only one breast cancer case was detected by FNAC alone (additional true positive rate 0.2 %). The positive predictive value of FNAC in the absence of other abnormalities was 5 %. The negative predictive value of a benign report at MG, PE, US and FNAC was 100 %.

Conclusions

All breast lesions should be evaluated by all available techniques, especially FNAC, and open biopsy should be avoided for those reported as benign at all tests.

Diagnostic reliability of combined physical examination, mammography, and fine-needle puncture ("triple-test") in breast tumors. A prospective study

A prospective study of 622 consecutively registered patients with 650 breast tumors was performed to appraise the reliability of combined physical examination, mammography, and fine-needle puncture (triple test) in the preoperative diagnosis of such tumors. All malignant as well as benign test results were confirmed by subsequent histologic examination. The diagnostic accuracy of the triple test at benign changes is comparable to that of histologic examination, but participation of experienced radiologists and cytologists as well as persons skilled in fine-needle puncture is required. Twenty-eight percent of the planned excisional biopsies were made superfluous by the fine-needle puncture, which immediately revealed the tumor as a cyst, abscess, or hematoma. For this reason, too, fine-needle puncture is recommended as a routine procedure.

Costs and benefits of breast cancer diagnosis

The data from 456 breast cancer patients treated between 1978 and 1985 were retrospectively analyzed to assess the validity of present methods in the diagnosis of breast cancer. The prices and benefits of the methods and the costs of the combinations were compared. The false negative rate of one single method varied from 11.8 to 20.9 per cent, with two methods the rate was 3.7 to 7.1 per cent, and with three methods 2.5 to 3.9 per cent. With four methods no improvement in the results was noted. As a single method, fine needle aspiration biopsy was the cheapest, but it also had the highest false negative rate. The combination of clinical examination, mammography, and fine needle aspiration biopsy seemed to be the most accurate and reasonable combination for diagnosis.