Diagnostic Accuracy of Triple Assessment in Breast Cancer: A Comprehensive Clinical Evaluation with Statistical Analysis

Abstract

Background: Triple assessment combining clinical breast examination, radiological imaging, and fine needle aspiration cytology represents the systematic diagnostic approach for evaluating breast masses and determining malignancy probability. Despite widespread utilization, comprehensive analysis of individual component performance and concordance patterns with statistical significance remains incompletely characterized in contemporary literature.

Methods: This retrospective study evaluated 340 consecutive women presenting with palpable breast lumps undergoing complete triple assessment evaluation. Clinical breast examination, diagnostic mammography with BI-RADS categorization (0–6 scale representing <2% to >95% malignancy risk), and ultrasound-guided fine needle aspiration cytology (classified as C1–C5 according to National Health Service Breast Screening Programme criteria) were performed. All patients underwent histopathological examination as the gold standard reference. Diagnostic accuracy metrics including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Statistical significance was assessed using chi-square analysis and McNemar's test with significance threshold of p<0.05.

Results: Combined triple assessment achieved 99.1% diagnostic accuracy (sensitivity 99.0%, specificity 99.3%, p<0.001). Individual modality sensitivities were clinical examination 76.9% (p<0.001), mammography 94.9% (p<0.001), and FNAC 94.7% (p<0.001). Concordant findings (80% of cases, n=272) demonstrated 100% sensitivity and 99.4% specificity. Discordant cases (20%, n=68) showed elevated malignancy risk of 86.8% (59 of 68 cases, p<0.001), with FNAC-driven discordance demonstrating 92.9% malignancy detection versus 11.1% for isolated clinical examination concerns (p<0.001).

Conclusion: Triple assessment achieves exceptional diagnostic reliability when all components are concordant, supporting clinical decision-making without additional biopsy in appropriately selected cases. Discordant presentations mandate heightened investigation, with FNAC demonstrating superior prognostic weighting. Triple assessment represents the gold-standard diagnostic paradigm for breast mass characterization and malignancy stratification.