Annals of surgical oncology · 2025
Added Value of Fine-Needle Aspiration (FNA) or Breast Magnetic Resonance Imaging (MRI) as Part of the "Triple Test" to Assess Palpable Abnormalities on a Breast Exam With Negative Imaging Findings.
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Slobin Jacqueline, Travers Grace, Perez Joan, Collins Victoria, Chen Christine, Port Elisa, Marti Jennifer L
Аннотация
BACKGROUND: When a breast abnormality is palpated on a clinical breast exam in the setting of negative imaging (mammography and/or sonography), fine-needle aspiration (FNA) or magnetic resonance imaging (MRI) often is performed as part of the "triple test" to rule out malignancy. Because the negative predictive value (>97 %) of modern breast imaging is high, we hypothesized that additional evaluation with FNA and MRI adds little diagnostic value.
METHODS: This study queried institutional databases to identify patients with negative breast imaging who underwent MRI or FNA for evaluation of a palpable breast abnormality on a clinical breast exam (2009-2023).
RESULTS: For 83 patients with 89 palpable abnormalities, the mean age was 48 years (interquartile range [IQR], 22.75 years). Two (2.4 %) of the patients had concurrent breast cancer. Of the 89 masses, 67 (75.3 %) underwent FNA only, 19 (21.3 %) underwent MRI only, and 3 (3.4 %) underwent FNA and MRI. The FNA findings were benign in 42 (60 %) cases, nondiagnostic in 25 (35.7 %) cases, atypical in 3 (4.3 %) cases, and malignant in 0 % cases. All MRIs were negative for an imaging correlate. For 12 masses, surgery was performed (11 excisional biopsies, 1 incisional biopsy), and all surgical pathology results were benign. During a median follow-up period of 6.6 years, no patients developed malignancy at the site of palpable abnormality, and six patients (7.2 %) developed breast cancer at other sites.
CONCLUSIONS: For women with palpable abnormalities and negative imaging, upgrade to malignancy with FNA or MRI was 0 %. We concluded that FNA or MRI as part of the "triple test" is a low-value intervention. Patients with a palpable breast abnormality may be safely followed with interval imaging.
METHODS: This study queried institutional databases to identify patients with negative breast imaging who underwent MRI or FNA for evaluation of a palpable breast abnormality on a clinical breast exam (2009-2023).
RESULTS: For 83 patients with 89 palpable abnormalities, the mean age was 48 years (interquartile range [IQR], 22.75 years). Two (2.4 %) of the patients had concurrent breast cancer. Of the 89 masses, 67 (75.3 %) underwent FNA only, 19 (21.3 %) underwent MRI only, and 3 (3.4 %) underwent FNA and MRI. The FNA findings were benign in 42 (60 %) cases, nondiagnostic in 25 (35.7 %) cases, atypical in 3 (4.3 %) cases, and malignant in 0 % cases. All MRIs were negative for an imaging correlate. For 12 masses, surgery was performed (11 excisional biopsies, 1 incisional biopsy), and all surgical pathology results were benign. During a median follow-up period of 6.6 years, no patients developed malignancy at the site of palpable abnormality, and six patients (7.2 %) developed breast cancer at other sites.
CONCLUSIONS: For women with palpable abnormalities and negative imaging, upgrade to malignancy with FNA or MRI was 0 %. We concluded that FNA or MRI as part of the "triple test" is a low-value intervention. Patients with a palpable breast abnormality may be safely followed with interval imaging.