Usefulness of the triple test score for palpable breast masses

Hypothesis: The triple test score (TTS) is useful and accurate for evaluati ng palpable breast masses. Design: Diagnostic test study Setting: University hospital multidisciplinary breast clinic. Patients: Four hundred seventy-nine women with 484 palpable breast lesions evaluated by TTS from 1991 through July 2000. Main Outcome Measures: Physical examination, mammography, and fine-needle a spiration were each assigned a score of 1, 2, or 3 for benign, suspicious, or malignant results; the TTS is the sum of these scores. The TTS has a min imum score of 3 (concordant benign) and a maximum score of 9 (concordant ma lignant). The TTS was correlated with subsequent histopathologic analysis o r follow-up. Interventions: The TTS was prospectively calculated for each mass. Lesions with a TTS greater than or equal to 5 were excised for histologic confirmat ion, whereas lesions with scores less than or equal to 4 were either excise d (n = 60) or followed clinically (n = 255). Results: All lesions with TTS less than or equal to 4 were benign on clinic al follow-up, including 8 for which the fine-needle aspiration was the susp icious component. Of the 60 biopsied lesions, 51 were normal breast tissue, 4 showed fibrocystic change, 1 was a papilloma, and 4 were atypical hyperp lasia. All lesions with a TTS greater than or equal to 6 (n=130) were confi rmed to be malignant on biopsy. Thus, a TTS less than or equal to 4 has a s pecificity of 100% and a TTS greater than or equal to 6 has a sensitivity o f 100%. Of the 39 lesions (8%) with scores of 5, 19 (49%) were malignant, a nd 20 (51%) were benign. Conclusions: The TTS reliably guides evaluation and treatment of palpable b reast masses. Masses scoring 3 or 4 are always benign. Masses with scores g reater than or equal to 6 are malignant and should be treated accordingly. Confirmatory biopsy is required only for the 8% of the masses that receive a TTS of 5.