A Modified Triple Test for Palpable Breast Masses: The Value of Ultrasound and Core Needle Biopsy

Wai, Christina; Al-Mubarak, Ghada; Homer, Michael; Goldkamp, Allison L.; Samenfeld-Specht, Marja; Lee, Yoojin; Logvinenko, Tanya; Rothschild, Janice G.; Graham, Roger A.

doi:10.1245/s10434-012-2710-y

Cited by 30 publications

(29 citation statements)

References 17 publications

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“…In fact, most women presenting with breast alterations will be found to have a benign diagnosis [5]. When first assessing a breast mass, the triple assessment approach to breast lesions is advocated in many countries, which combines clinical, radiologic, and pathologic information to ensure accurate diagnosis and patient management [6, 7]. Traditionally, the triple test consisted of clinical examination, mammography, and FNAB.…”

Section: Discussionmentioning

confidence: 99%

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Breast Fine Needle Aspiration Biopsy Cytology Using the Newly Proposed IAC Yokohama System for Reporting Breast Cytopathology: The Experience of a Single Institution

2019

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Objective: Recently the International Academy of Cytology (IAC) proposed a new reporting system for breast fine needle aspiration biopsy (FNAB) cytology. We aimed to categorize our samples according to this classification and to assess the risk of malignancy (ROM) for each category as well as the diagnostic yield of breast FNAB. Study Design: Breast FNAB specimens obtained between January 2007 and December 2017 were reclassified according to the newly proposed IAC Yokohama reporting system. The ROM for each category was determined. Diagnostic yield was evaluated based on a three-category approach, benign versus malignant. Results: The samples were distributed as follows: insufficient material 5.77%, benign 73.38%, atypical 13.74%, suspicious for malignancy 1.57%, and malignant 5.54%. Of the 3,625 cases collected, 776 (21.4%) had corresponding histology. The respective ROM for each category was 4.8% for category 1 (insufficient material), 1.4% for category 2 (benign), 13% for category 3 (atypical), 97.1% for category 4 (suspicious for malignancy), and 100% for category 5 (malignant). When only malignant cases were considered positive tests, the sensitivity, specificity, and diagnostic accuracy were 97.56, 100, and 99.11%, respectively. Conclusions: Our study is the first to categorize breast FNAB cytology samples according to the proposed IAC reporting system and to evaluate patient outcomes based on this categorization.

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Section: Discussionmentioning

confidence: 99%

“…Traditionally, the triple test consisted of clinical examination, mammography, and FNAB. Over recent years, the definition has been expanded to include ultrasound in selected age groups (young women) and CNB as an alternative to FNAB cytology [7, 8]. …”

Section: Discussionmentioning

confidence: 99%

Breast Fine Needle Aspiration Biopsy Cytology Using the Newly Proposed IAC Yokohama System for Reporting Breast Cytopathology: The Experience of a Single Institution

2019

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“…Even though palpable or non-palpable probably benign lesions have a short-interval imaging follow-up recommended rather than biopsy, the triple test (physical examination, mammogram, and fineneedle aspiration) or modified triple test (physical examination, mammography and/or ultrasonography, and fine-needle aspiration and/or biopsy) has been used to evaluate palpable lesions in clinical practice [5]. However, there is relatively little research on the accuracy of core needle biopsy for palpable lesions [6-9] and, in particular, on its ability to identify borderline lesions.…”

Section: Introductionmentioning

confidence: 99%

Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

2014

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Purpose:To evaluate the accuracy of benign core biopsy of probably benign breast lesions (category 3) 2 cm or larger on the basis of excisional biopsy and long-term follow-up. Methods:We retrospectively reviewed 146 category 3 lesions in 146 patients 2 cm or larger which were diagnosed as benign by ultrasound (US)-guided core biopsy. Patients were initially diagnosed as benign at core needle biopsy and then followed up with excisional biopsy (surgical excision, n=91; US-guided vacuum assisted excision, n=35) or breast ultrasonography (n=20). Results:Of the 126 patients who underwent surgical excision or US-guided vacuum-assisted excision, 114 patients were diagnosed with benign lesions, 10 patients with borderline lesions (benign phyllodes tumor), and two patients with malignant phyllodes tumors. The probabilities of lesions being benign, borderline and malignant were 91.8% (134/146), 6.8% (10/146), and 1.4% (2/146), respectively. Of 13 patients who had growing masses on follow-up ultrasonography, three (23.1%) were non-benign (two benign phyllodes tumors and one malignant phyllodes tumor). Conclusion:US-guided core needle biopsy of probably benign breast mass 2 cm or larger was accurate (98.6%) enough to rule out malignancy. But, it was difficult to rule out borderline lesions even when they were diagnosed as benign.

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“…In conjunction with physical examination and radiological findings, a diagnostic triad commonly known as the triple test, FNA cytology (FNAC) of palpable breast lesions has been shown to have a sensitivity of 92.7-93.0% and a specificity of 94.8-98.0% for breast carcinoma [1,2]. Although core biopsy has gradually eclipsed breast FNAC in popularity because it offers an improved ability to distinguish invasive from in situ carcinoma and an increased availability of tissue for prognostic studies, large studies have confirmed that FNAC has equivalent accuracy in distinguishing benign from malignant tumors [3,4,5]. Moreover, FNAC has been shown to be more cost-effective than core biopsy for palpable lesions [6] and remains an important diagnostic tool in low-resource settings.…”

Section: Introductionmentioning

confidence: 99%

Atypical Hidradenoma Mimicking Primary Mammary Carcinoma on Breast Fine-Needle Aspiration: A Case Report with Long-Term Follow-Up

Rooper

Iding

Cuda³

et al. 2016

Acta Cytologica

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Background: Fine-needle aspiration (FNA) is well-established as an accurate technique for the diagnosis of palpable breast masses. While the differential diagnosis of such lesions usually focuses on benign or malignant mammary proliferations, a subset of breast neoplasms arises from skin and soft tissue. Skin adnexal neoplasms such as hidradenoma can pose a particular pitfall on breast FNA cytology (FNAC) as epithelial proliferations that are not of ductal or lobular origin. Case: A 59-year-old female presented with a superficial breast mass. FNAC revealed a hypercellular lesion with marked nuclear atypia that was highly suspicious for carcinoma. However, at partial mastectomy, the histological features of the tumor were consistent with atypical hidradenoma. Negativity for estrogen receptor (ER) and progesterone receptor (PR) confirmed the diagnosis. Eighteen years later, the patient remains free of recurrence or metastasis. Conclusions: This report offers the first description of findings of atypical hidradenoma on FNAC. In the breast, its high cellularity and nuclear atypia can mimic a primary mammary carcinoma on FNAC. Although breast and skin adnexal tumors show a immunohistochemical overlap, negative ER and PR stains in a low-grade tumor can suggest a nonmammary lesion. Skin adnexal neoplasms should be considered in the differential diagnosis of superficial breast tumors.

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A Modified Triple Test for Palpable Breast Masses: The Value of Ultrasound and Core Needle Biopsy

Cited by 30 publications

References 17 publications

Breast Fine Needle Aspiration Biopsy Cytology Using the Newly Proposed IAC Yokohama System for Reporting Breast Cytopathology: The Experience of a Single Institution

Breast Fine Needle Aspiration Biopsy Cytology Using the Newly Proposed IAC Yokohama System for Reporting Breast Cytopathology: The Experience of a Single Institution

Benign core biopsy of probably benign breast lesions 2 cm or larger: correlation with excisional biopsy and long-term follow-up

Atypical Hidradenoma Mimicking Primary Mammary Carcinoma on Breast Fine-Needle Aspiration: A Case Report with Long-Term Follow-Up

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