Role of triple test in diagnosis of palpable breast masses at Moi Teaching and Referral Hospital

Abstract

Background: Breast masses both benign and malignant contribute to morbidity in women. Breast masses result from many factors including environmental and genetic. There is need for proper and prompt evaluation of patients presenting with breast masses for diagnosis and treatment. Diagnosis of breast masses is done through clinical breast examination, radiological examination, fine needle aspiration for cytology and histology. A combination of these methods in the triple test is useful for improved accuracy. Objective: This study aims to determine the accuracy of triple test for evaluation of palpable breast masses in patients presenting at the Moi teaching and referral hospital. Study site: MTRH surgical wards and surgical out-patient Clinics Study design: a prospective cross sectional study. Study subjects: eligible patients presenting with palpable breast masses at MTRH Study methods: Data was collected in a hospital based study using a structured interviewer administered questionnaire. The data was collected through interviews, physical examination, and radiological examination, cytological and histological examination. The data was analyzed using both descriptive and statistical methods. Study results: The data for the study was collected for a period of one year between December 2012 and November 2013. 50 respondents were recruited into the study. 47(94%) of the respondents were female and 3(6%) were male; giving a female : male ratio of 15.7:1. The respondents’ ages ranged between 16 – 85 years, with a mean age of 36 + 18 years. The accuracy of triple test done during the study is sensitivity (86.8%), specificity (96.7%), positive predictive value (97.3%) and negative predictive value (85.3%). The overall accuracy of the triple test is 91.2% while the positive likelihood ratio is 26.3 and negative likelihood ratio is 0.14. 28% of the respondents reported a positive family history of breast disease; 28.6% of these had a positive family history of breast cancer. 86.1% of the respondents practice breast feeding and 43.5% reported a positive history of prolonged hormonal contraception. The respondents presented with breast masses ranging between 1 – 12 cms in diameter. The characteristics of the breast masses included: firmness (72%), irregular surface (32.7%), pain / tenderness (48%), breast contour changes (46.9%), presence of nipple discharge (46%); 4% of who had bloody nipple discharge, skin ulceration (20%), and presence of associated axillary lymphadenopathy (34%);. The diagnoses of breast masses included: mastitis / abscess (36.0%), breast cancer (26.0%), fibroadenomas (22.0%), fibrocystic changes (6.0%), ductal ectasia (4.0%), Galactocele (4.0%) and gynaecomastia (2.0%). Conclusion and recommendations: The triple test showed acceptable level of accuracy for diagnosis of breast masses. MTRH should consider developing a protocol for evaluation of breast masses that includes triple test for prompt and accurate diagnosis for breast masses.