Diagnostic Approach to Palpable Breast Lump - A Quadruple Assessment

The vast majority of the lesions that occur in the breast are benign. Much concern is given to malignant lesions of the breast because breast cancer is the most common malignancy in women in Western countries, however, benign lesions of the breast are far more frequent than malignant ones. With the use of mammography, ultrasound, and magnetic resonance imaging of the breast and the extensive use of needle biopsies, the diagnosis of a benign breast disease can be accomplished without surgery in the majority of patients. Because the majority of benign lesions are not associated with an increased risk for subsequent breast cancer, unnecessary surgical procedures should be avoided. It is important for pathologists, radiologists, and oncologists to recognize benign lesions, both to distinguish them from in situ and invasive breast cancer and to assess a patients risk of developing breast cancer, so that the most appropriate treatment modality for each case can be established. The first step in evaluation of breast lump is the clinical assessment. Although many a times clinician can confidently make the diagnosis of benign or malignant lesion, the possibility of mistake is always there even in experienced hands. The triple test for breast diseases involve, Clinical assessment Imaging modality Mammography Fine needle aspiration biopsy/cytology In modified triple test ultra sonogram is used instead of mammography. Clinical diagnosis of breast cancer is of higher sensitivity than specificity and has high diagnostic error. Mammography and FNAC respectively have lower sensitivity than specificity but have high positive predictive values. When combined in the triple assessment, a definitive diagnosis can be made when the diagnoses concur, suggesting that the triple assessment has a high sensitivity, specificity, positive predictive value and negative predictive value with minimal error and excellent Kappa statistic. The output of the triple assessment in reproducible, making it a valid and reliable diagnostic approach to diagnosis of breast cancer. Mammography is the proven and preferred method for breast cancer screening. But when mammography reveals a non-palpable breast lesion further imaging studies are often required to more precisely identifying the characteristics and location of the mass. The first attempts to use radiography for the diagnosis of breast abnormalities were made in the late 1920s, but mammography, as we understand it nowadays, using dedicated X-ray units, was developed in the 1960s. During the past 2 decades a number of additional methods for assessing breast lesions have been investigated. These include Thermography, Radioisotope scanning, ultrasound, computed tomography, and magnetic resonance imaging. Ultrasonographic examination of the breast is an extremely effective diagnostic tool when used in conjunction with physical and mammographic examination. It is painless, requires no roentgenographic exposure, and with proper training it can be easily performed in a timely, convenient manner.