DIAGNOSIS OF BREAST CANCER AND THE TRIPLE TEST

Karen Gatlin

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The evaluation of breast masses is based on the "triple test" which focuses on three factors to determine the likelihood that a breast lump may be breast cancer. The following are the factors to consider: 1) History and Physical Examination; 2) Radiologic Findings (mammographic and ultrasound findings); and 3) Biopsy if a mass persists.

Each factor is evaluated and the test must be "concordant" for breast cancer to be ruled out as a possibility. If a mass persists, fine needle aspiration, followed by biopsy, must be done, even if mammography does not show a mass. Likewise, biopsy must be done to rule put cancer if mammography shows a mass which is not palpable on physical examination. If, however, history and physical examination as well as mammographic findings are normal, then a needle biopsy is not warranted.

All three factors must be considered once a biopsy is done. Even If the biopsy is negative, if there were a suspicious finding on the mammogram , a lumpectomy or repeat biopsy would be warranted. Simply accepting the negative (benign) needle biopsy result in the presence of the other suspicious findings would not meet the standard of care. If a mass on clinical evaluation is highly suggestive of malignancy or the mammogram is highly suspicious of malignancy, then the lump must come out regardless of the fact that there was a negative needle aspiration and biopsy. In summary, if the clinical findings and the imaging don't agree with a benign biopsy, then the lump has to come out. This is the Triple test.