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.