Analysis of inconclusive breast FNA by triple test

To evaluate the efficiency of triple test for non-diagnostic (inconclusive and inadequate) FNAs of palpable breast lesions and to compare our results with the literature.

A retrospective analysis was done on cases that were having cyto-histological correlation with clinical and radiological follow up. Out of 446 FNAs performed at our institute during the period of 15 years, only 16 cases were discovered fulfilling the above criteria and these were reviewed blindly and scored. The triple test was applied to each case. Each component of the triple test was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total triple test score (TTS) of these 16 cases.

Three out of 16 specimens were unsatisfactory and rest 13 cases inconclusive (i.e., suspicious) cytologically, diagnosed as having scant atypical cells. All malignant cases scored above 6 except one case that scored 5. The two benign cases scored 1 and 3. On histological follow up 2 of the unsatisfactory cases turned out as fibroadenoma (scored 1 and 3) and one as malignant (scored 5). Among inconclusive cases all turned out to be malignant on histological follow up (all scored 6 and above). High clinical suspicion was present in all 14 cases that were proved malignant in histological follow up. Radiological diagnosis of malignancy was present in 11 of 14 malignant cases, suspicious in two malignant cases and in 1 of 2 fibroadenoma cases. All cases underwent surgical removal of the mass as a result of clinical or radiological suspicion.

Triple test can reliably guide the evaluation and treatment of palpable breast masses. Masses that score 6 points or higher are malignant and should undergo definitive therapy; masses that score 4 points or lower are benign and may be clinically followed up. Only those masses that score 5 points require open biopsy. Our results were in concordance with other larger studies published in the literature. We recommend utilizing the three diagnostic parameters of cytology, clinical findings and radiology, the triple test, to achieve the best diagnostic accuracy in breast FNAs and patient management.