Modified Triple Test Score (MTTS) for Evaluation of Palpable Breast Masses in Women Under Age 40

Background: Evaluation of breast masses in women under 40 years old starts with a Triple Test Score (TTS) which is composed of clinical breast examination, mammography and fine needle aspiration. Increased breast density in this age group decreases the sensitivity of mammography. So deciding whether to biopsy such nondiagnostic lesions or not is subject to challenge. Breast masses up to 2mm could be observed by ultrasonography using probes with high frequencies (10-13 MHz) with a specificity and sensitivity of more than 80%.
Methods: This study was conducted to evaluate the efficacy of ultrasonography instead of mammography in triple test scores (TTS) of nondiagnostic breast masses in women under 40 years of age and compare the results with open biopsy. To address this issue, breast masses in 100 randomly selected women under 40 were evaluated utilizing physical examination, breast ultrasonography and FNA as a modified triple test score (MTTS) which assigned score 1 for benign, score 2 for suspicious and score 3 for malignant results in each component of TTS. Summation of these three scores was assigned as MTTS. Thereafter all masses were evaluated by open biopsy.
Results: Among 100 masses in 100 women, 69 scored 3 points, 15 scored 4 points; all of them were benign. Four scored 5 points; 1 of them was malignant. Five scored 6 points; three of them were malignant. Seven scored 7, 8, and 9; all of them were malignant.
Conclusion: The MTTS is with 100% diagnostic accuracy for malignancy when it is greater than 7 points. Masses scoring 4 points or lower are benign. Seven up to nine points may proceed to definitive therapy. Five and six points need clinical evaluation and open biopsy. The results of MTTS are similar to TTS in evaluation of breast masses in women under 40 years old and could avoid unnecessary open breast biopsy.