Triple test approach to inadequate fine needle aspiration biopsies of palpable breast lesions

OBJECTIVE: To perform a retrospective study evaluating the triple test for inadequate fine needle aspiration (FNA) biopsies of palpable breast lesions with a two-yens clinical follow-up. STUDY DESIGN: All aspirates were reviewed and assessed for cellular adequac y in a one-year period. Specimen adequacy was based on the most stringent c riteria, the presence of six or more epithelial cell clusters composed of a t least six cells each. In all cases, clinical and radiologic results were reviewed and compared with the histologic outcome. RESULTS: Aspirates from 61 of 263 (23%) patients with palpable breast lesio ns that yielded nondiagnostic results were examined. The study showed a mis directed FNA rate of 21% and a misinterpreted rare of 1.6%. The other 77% o f cases had benign surgical biopsies and/or clinical follow-up. Three of 61 (4.9%) cases with nondiagnostic smears were found to have cancer; two were inadequate due to misdirected aspirates, and one was misinterpreted micros copically. All cancer cases underwent surgical removal of the mass as a res ult of clinical or radiologic suspicion. CONCLUSION: We recommend utilizing the three diagnostic parameters of cytol ogy, clinical findings and radiology, the "triple test," to achieve the bes t diagnostic accuracy in breast FNAs and to enhance patient management.