Abstract

TRIPLE ASSESSMENT IN THE DIAGNOSIS OF BREAST NEOPLASMSWHAT HAPPENS IN NON-CONCORDANT CASES?

Author(s): Rajalakshmi P1, Sreenivas N2, Shubha Jayaram3

INTRODUCTION: Triple assessment and its components are widely used for the evaluation of breast neoplasms. The efficacy of these modalities varies in different studies. While its usefulness is usually studied for the concordant cases, analysis of the non-concordant cases is all the more important.

OBJECTIVES: To assess the diagnostic value of triple assessment and its components for the evaluation of palpable breast neoplasms with an emphasis on non-concordant cases

METHODS: The study included 105 cases of breast neoplasms over 18 months. Mammograms were reported using BI-RADS and cytology smears using the five scale reporting system. The clinical, mammographic and cytologic diagnoses were compared with histopathologic diagnosis

RESULTS: Clinical examination (CE) showed the highest sensitivity (86%) and negative predictive value (88.33%) while FNAC (Fine Needle Aspiration Cytology) was highly specific (100%). By using various combinations of the individual modalities, sensitivity was found to be highest (97.06%) when CE and mammography were concordant and specificity was maximal (100%) when FNAC concurred with either CE or mammography. The triple assessment was concordant in 73.33% of cases with 100% accuracy. Among the non-concordant cases, when at least one method diagnosed malignancy, 84% of them were confirmed on biopsy. Also, CE had the highest chance of detecting malignancy either singly or in combination with either of the other two modalities in non-concordant cases.

CONCLUSIONS: Multidisciplinary approach enhances the accuracy of diagnosing breast neoplasms and when one of the diagnostic methods is indicative of malignancy, further investigations must be performed to rule out the same.

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