“Diagnostic Accuracy And Predictive Value Of Modified Triple Test Components Against Histopathology In Breast Lump Evaluation”

Abstract

Background: Breast lumps are a common clinical presentation in women, requiring accurate and timely differentiation between benign and malignant pathology. The Modified Triple Test Score (MTTS), which includes Clinical Breast Examination (CBE), radiological imaging, and cytopathology, serves as a cost-effective, structured diagnostic tool. Its validation against histopathology may optimize decision-making, particularly in resource-constrained settings.

Objectives: To determine the diagnostic accuracy and predictive value of each MTTS component and the overall score by comparing them with final histopathological examination (HPE) results in patients with palpable breast lumps.

Methods: This prospective observational study was conducted from January 2023 to March 2024 at a tertiary care hospital in Dehradun. Sixty female patients aged over 18 years with palpable breast lumps underwent clinical examination, sonomammography, and FNAC/core biopsy. Each MTTS component was scored (1–3), with a total score ranging from 3 to 9. Scores of 3–4 were considered benign, and ≥6 as malignant. Final diagnoses were confirmed by histopathology. Diagnostic metrics including sensitivity, specificity, PPV, NPV, and accuracy were calculated.

Results: Among 60 patients, 39 (65%) were histologically benign and 21 (35%) malignant. CBE and pathological assessments both achieved 100% sensitivity, specificity, and accuracy. Radiology showed 57.14% sensitivity and 100% specificity. MTTS demonstrated 100% sensitivity but low specificity (46.15%) and overall accuracy of 65%. Suspicious FNAC cases were all benign, highlighting potential overestimation.

Conclusion: MTTS is a highly sensitive tool for evaluating breast lumps but may overestimate malignancy due to low specificity. CBE and pathology remain the most accurate components. MTTS can aid early triage, but refinement in scoring may improve predictive accuracy.