Journal of Clinical and Diagnostic Research. 2022 Jun, Vol-16(6): PC01-PC04 1 1 DOI: 10.7860/JCDR/2022/52732.16438 Original Article General Surgery Section Triple Assessment for the Diagnosis of Carcinoma Breast in a Tertiary Care Hospital of Tripura: A Cross-sectional Study INTRODUCTION Breast cancer is the most common cancer in women worldwide, with nearly 1.7 million new cases diagnosed every year and second most common cancer overall representing about 12% of all new cancer cases and 25% of all cancers in women [1,2]. It is also the most common cause of cancer mortality among women in developing countries and second most common in developed countries. Signs of breast cancer varies, and may include change in the breast shape, dimpling of the skin, fluid coming from the nipple or a red scaly patch of the skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath and yellow skin [3]. However, the most common way the disease presents itself is with the presence of a growing lump in the breast that is felt by the woman [1]. An estimated 1,45,000 new breast cancer patients are diagnosed annually in India and about 76,000 women are expected to die from the disease every year [2,4,5]. It has been suggested that the primary reason for such a high mortality among breast cancer patients in the country is the fact that the early diagnosis of the disease is still very low. Most of the breast cancer patients have no access to screening procedures, and in cases where screening is availed, adequate follow-up of the patients do not occur. This leads to most of the breast cancer cases progressing to a more advanced form of the disease which is associated with much poorer prognosis and outcomes [1]. In Tripura, breast cancer is the one of the commonest forms of cancer among females, second only to uterine cancer [6]. Although the diagnosis of breast cancer can be suggested by clinical examination, it largely depends on the degree of clinical suspicion of the disease. Presence of a lump or space occupying lesion in the breast raise suspicion of being benign or malignant. Differential diagnosis of breast lesion includes traumatic fat necrosis, acute and chronic breast abscess, fibro-adenosis, breast cysts etc. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath and yellow skin [7,8]. Furthermore, patients who are overtly cautious and fearful of cancers can feel a lump in their breasts even when none exists. Histopathological examination of tissue from a suspected lesion remains the gold standard for the diagnosis of breast cancer. However, since the procedure is invasive, other modalities have since been developed to screen for and diagnose the disease [7]. A combination of invasive and non-invasive procedures, i.e. clinical examination, radiological imaging (mammography/ ultrasonography/ Magnetic Resonance Imaging (MRI)) and fine needle aspiration cytology called the triple assessment test have been used with a fairly high accuracy to diagnose palpable breast lumps. Studies have been done comparing triple assessment with histopathology in the diagnosis of breast cancer. However, a thorough literature search of the existing literature revealed that there were very few studies that have been done to explore this scenario in India [4,8]. As the availability, accessibility and utilization of cancer screening services are still low in the country, this study aims to fill in the gaps that exist in the existing knowledge regarding the accuracy of triple assessment in the Indian setting, especially in Tripura. The aim of this study was to evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma and to determine sensitivity and specificity with regards to histopathology in the diagnosis of the disease. TAMAL SARKAR 1 , DAMODAR CHATTERJEE 2 , DIPTENDU CHOWDHURY 3 , PRADIP SARKAR 4 Keywords: Carcinoma breast, Triple assessment, Sensitivity, Specificity ABSTRACT Introduction: A combination of invasive and non-invasive procedures, clinical examination, radiological imaging (mammography/ ultrasonography/ Magnetic Resonance Imaging (MRI)) and fine needle aspiration cytology called the triple assessment test is being increasingly used in place of the more invasive core needle biopsy and histopathology. Aim: To evaluate accuracy of triple assessment in the preoperative diagnosis of patients with breast carcinoma and to determine sensitivity and specificity with regards to histopathology in the diagnosis of the disease. Materials and Methods: A cross-sectional study was conducted among 61 women of more than 25 years of age having palpable breast lump, attending the surgery Outpatient Department (OPD) and breast clinic of a tertiary care hospital from January 2017 to February 2019. Data on socio-demographic status, menstrual and obstetric information, clinical examination performed, mammography, Fine Needle Aspiration Cytology (FNAC), High resolution sonography breast and histopathology were recorded into predesigned and pretested proformas and analyzed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Out of total 61 patients participated in the present study, most patients were of 41-50 years of age, with a mean age of 44.23±7.37 years, married, non-vegetarian and without any past history of alcohol consumption. Sensitivity and specificity of triple assessment was 98.3% and 100% respectively. The positive predictive value of Triple Assessment was 100% while the negative predictive value was 66.7%. All values were significantly better than both clinical breast examination and FNAC in detecting malignancies. Conclusion: The triple test was also found to be as accurate in diagnosing breast carcinoma in this geographical region. A patient with a negative triple test report can be safely followed up without the need for biopsy.