Triple assessment as a preoperative diagnostic tool for breast cancer at Bugando Medical Centre in northwestern Tanzania

Abstract

The triple assessment in the pre-operative evaluation of breast cancer has been practiced in some hospitals in Tanzania. However, its validity and reliability has not been evaluated in any hospital in the country including the study area. This cross-sectional study was conducted at Bugando Medical Centre in northwestern Tanzania to determine the validity, reliability and applicability of triple assessment as an alternative to conventional open biopsy in the pre-operative diagnosis of breast cancer. A total of 212 female patients aged 35 years and above were studied. All patients underwent clinical evaluation, mammography and fine needle aspiration cytology. Histopathology was done to confirm the diagnosis. One hundred and twenty (56.6 %) patients with a median age of 36 years had benign lesions and the remaining ninety-two (43.4%) with a median age of 47 years had breast cancer (P = 0.002). With triple assessment, 92 patients were diagnostic for malignancy and 120 benign, respectively confirmed by histopathology. The Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Accuracy were 100.0%. There were no false positive or false negative results. The Kappa statistic for the combination was 1.0 implying excellent agreement with histopathology. The majority of patients (59.9%) underwent triple assessment on the same day with results being available to the patient within 24 to 72 hours. The triple assessment is an accurate and quick method for the evaluation of breast cancer and can be applied as a safe alternative for open biopsy when it is concordant.. ______________________________________________________________________________________

Comparison of Ultrasonography and Fine Needle Aspiration Cytology in the Diagnosis of Malignant Breast Lesions in a Rural Setup

“…Sampling error can be minimized by proper localization and aspiration technique performed by experienced pathologist. 3,28 A 100% specificity and 100% PPV result means that if FNAC gives a positive result (malignant report), it definitely means presence of the disease. It can be considered confirmatory and further treatment decision can be made solely on this report without any further additional diagnostic investigation.…”

“…Therefore, a distinction of benign from malignant is of paramount importance for patient and proper management. 3 A definitive diagnosis of benign lesion not only saves the patient from unnecessary stress, but also relieves the health services from undue burden. On the contrary, a definitive preoperative diagnosis of malignant lesion provides many opportunities for patient's counseling and planning of possible single-stage surgical treatment.…”

“…On the contrary, a definitive preoperative diagnosis of malignant lesion provides many opportunities for patient's counseling and planning of possible single-stage surgical treatment. 3 Cancer of the breast can present either as a lump or a nipple discharge. 4 Evaluation of this breast lump involves the rational use of a detailed history, clinical breast examination, imaging modalities, and tissue diagnosis, i.e., TRIPPLE ASSESSMENT.…”

“…This includes ultrasound Doppler scanning, fine needle aspiration cytology (FNAC), mammography (MMG), and recently, magnetic resonance imaging (MRI) and contrastenhanced ultrasound. 3 However, due to the higher cost IJRSMS of MMG and MRI and their limited availability, not all patients can benefit from this. This suggested the preferred use of less expensive and affordable diagnostic tools like FNAC and ultrasonography (USG).…”

“…It is even less traumatic and virtually painless procedure with no requirement of anesthesia, giving high percentage of true positive results, thus making it patient-friendly standard tool for diagnosis in breast lumps. 3,8 Although the accuracies of FNAC and USG in the diagnosis of breast lumps have been tested individually in many studies, yet there is a dearth of literature in comparison of the two modalities for evaluation of the same. Thus this study was proposed to evaluate and compare the accuracy of USG and FNAC in the diagnosis of newly detected palpable breast lump in comparison to the final HPE report of the biopsied specimens.…”