Abstract
Background and objectives: Breast lumps in women are a common clinical problem that requires rapid and accurate evaluation with an important aim of excluding any malignancy. The classical triple test includes physical examination, mammogram and fine needle aspiration cytology. We have modified this approach by substituting mammogram with ultrasound for the assessment of breast lesions. The objective of the study was to evaluate the accuracy of this modified triple test (MTT) in the management of palpable breast lumps. Patients and methods: A prospective cross sectional study was conducted at Mahatma Gandhi Medical College and Research Institute. Eighty patients with palpable breast lumps were assessed by all the components of MTT. The results of individual components as well as the overall MTT were compared with the final histopathological examination.
Results: Physical examination showed 96.67% sensitivity, 84% specificity and 78.4% positive predictive value for diagnosing malignant breast lumps. Ultrasonography showed 93.10% sensitivity, 95.9% specificity and 93.1% positive predictive value. Fine needle aspiration cytology (FNAC) showed 96.6% sensitivity, 100% specificity and 100% positive predictive value and the modified triple test showed 100% sensitivity, 82% specificity and an accuracy rate of 88.7%. Conclusions: The triple test is 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant (benign or malignant). Among the three components, FNAC had the highest specificity. MTT is reliable in guiding the clinician in the efficient management of patients with breast lumps. MTT is beneficial in reducing the number of unnecessary open biopsies to confirm the diagnosis. The output of MTT is easily reproducible, making it a valid and reliable diagnostic test in the management of palpable breast lumps.

Key words: modified triple test, mammogram, breast lump, accuracy