Clinical examination, mammography, and fine-needle aspiration cytology in the management of palpable breast masses

The combination of examination, mammography, and fine-needle aspiration cytology is increasingly being used to identify palpable breast masses that can be followed rather than excised. Since all three modalities are highly dependent on training and experience, causing the accuracy of the triple test to be highly variable, we examined the results of our own experience, expecting to find at least one triply false-negative cancer. Consecutive patients (198) with breast masses subjected to clinical examination, mammography, fine-needle aspiration cytology, and confirmatory excisional biopsy were studied. Sensitivity and specificity were calculated for all combinations of the three diagnostic methods and the significance of concordant and discordant findings was evaluated. The sensitivities of examination, mammography, and cytology were 96%, 82%, and 85% respectively and the specificities were 75%, 90%, and 82%. No cancers were missed when all three diagnostic modalities were used together. Benign concordance of examination, mammography, and cytology was invariably associated with benign pathology. These results validate the use of the triple test in our hands. However, the accuracy of the triple test will vary from physician to physician and its validity in following benign lesions must be evaluated with confirmatory excisional biopsies.