Systematic Use of the Clinical-Mammographic-Cytologic Triplet for the Early Diagnosis of Mammary Carcinoma

Abstract

Of about 8500 women with a minimum age of 30 years who had a breast examination at our Ouptatient Clinic from April 1982 to March 1983, we found in 286 cases a clinically evident carcinoma, and in 534 cases an apparently benign or suspect solid lump. All 534 of these cases were subjected to the triplet clinical, mammographic and cytologic diagnostic investigation by needle aspiration within 1 to 4 days. The clinical judgment was based on a method of scoring of the characters of 9 physical features (Clinical Diagnostic Index) in use at our Institute. The results of the examinations were grouped into 5 categories: 1) certain benignancy or negativity of the examination; 2) probable benignancy (excluding the cytologic examination); 3) probable malignancy; 4) certain malignancy; 5) nonevaluability of the examination (excluding the clinical examination). Except for 80 cases with collectively negative examinations which were clearly or completely regressed at the control within 2 months, all the others were subjected to surgery. On the basis of the histologic examination (or if regression occurred), 284 of the 534 lumps examined were found to be benign or nontumoral, whereas the other 250 (47%) were carcinomas. Of the latter, 57% were not more than 20 mm in size, whereas in 67.6% there was no microscopic evidence of axillary metastases. Sensitivity of the clinical, mammographic and cytologic examinations was 0.79, 0.76 and 0.72, respectively; specificity 0.71, 0.75 and 0.94, respectively, and the predictive value for malignancy of the positive response of the three examinations 0.71, 0.75 and 0.93, respectively. The use of the diagnostic triplet demonstrated an overall sensitivity of 0.95, specificity of 0.59, and a predictive value for malignancy of 0.98 and 0.93 for benignancy. These results confirm the usefulness of the systematic use of the diagnostic triplet in solid breast lumps of over thirty aged women for the early detection of cancer.

Clinical Examination, Mammography, and Fine-Needle Aspiration Cytology in the Management of Palpable Breast Masses

“…Sensitivity of clinical examination alone was 96% compared to 51439% in previous studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Clinical examination alone was the single most sensitive modality in this series for several reasons.…”

“…This relatively low sensitivity of mammography for palpable masses is a common finding in many studies. The sensitivity of mammography ranges from 76% to 96% (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13) with the highest sensitivities reported most recently, benefiting from advances and refinements in mammography. Smaller cancers were significantly more likely to be missed by mammography than larger cancers.…”

“…Significant refinements in both mammography and cytology have appeared since the triple test was first introduced causing preoperative or nonoperative diagnosis to be much more accurate (6)(7)(8)(9)(10). Many studies have correlated the results of the triple test with findings at excisional biopsy (1)(2)(3)(4)6,7,9,11) and a few have followed patients with concordant benign findings without excisional biopsy (5,7,8,10,12,13). Unfortunately, all three modalities, clinical examination, mammography, and fine-needle aspiration cytology are dependent in varying degrees on subjective factors.…”

Accuracy of Fine-Needle Aspiration of Breast Masses and Comparison with Palpation and Mammography

“…In this study, physical examination and mam mography had lower specificities in compari son to cytology due to the false-positive and false-suspicious diagnoses. However, false positive diagnoses have been recorded in FNA, even by experienced cytopathologists [6,7], To avoid an unnecessary mastectomy due to a false-positive cytodiagnosis, a diag nostic triplet of palpation, mammography and FNA is suggested [4,[8][9][10][11][12], Only a com bination of positive reports is sufficiently spe cific to warrant definite therapy without a fro zen section [4,8,12], However, as rare breast tumors with a false-positive triplet have been reported, some centers prefer to perform fro zen sections for breast tumors even with a positive triplet result [13,14], False-negative reports of breast masses are more difficult to avoid in cytodiagnosis due to sampling errors [5]. Sensitivity of cytology ranged from 70 to 99% (3-35% of false nega tive results) [1,5,14].…”

“…Although breast cancers with negative diagnostic triplet (palpation, mammography and FNA) results have been reported, nega tive triplet has sufficient accuracy to avoid open biopsy in many clinical situations [4,8].…”