Triple test assessment and a scoring system to predict the presence of breast cancer at Aga Khan University Hospital, Nairobi
Date of Award
Master of Medicine (MMed)
General Surgery (East Africa)
Background: Breast cancer is an emerging health concern in Africa. It is the most common female cancer in Kenya. The accuracy of the diagnostic modalities in our institution has not been previously assessed, especially in cases where components of the Triple Test (TT) are non-concordant.
Objectives: To retrospectively evaluate the accuracy of TT, its components and its modification; the Triple Test Score when the components are nonconcordant at Aga Khan University Hospital, Nairobi.
Methods: Using ICD9 611.72 we identified patients with breast lump or mass in the period between January 2000 and July 2007. One hundred and thirty nine patients who had all the three components of TT with a complete histology report were recruited. Negative results for each component (Clinical Breast Examination, Mammography, and Fine Needle Aspiration Cytology) were awarded a score of 1 and positive results, each scored 2, 3 and 5 for CBE, mammogram and FNAC respectively.
Results: Eighty three patients had non-concordant results. Forty two out of the 56 remaining were concordant for malignancy and 14 were concordant for benign disease. The sensitivities and specificities for the components were 83% & 72%, 53% & 72% and 88% & 75% for CBE, mammography and FNAC respectively. TT had sensitivity of 95.2% and specificity of 100%. A score of 8-10 (n=92) accurately predicted malignancy 94.4% of the time (Positive Predictive Value). A score of 5-7 (n=28) was only 64.3% accurate in predicting malignancy (Positive Predictive value). A score of 3-4 (n=19) predicted benign disease accurately 89.5% of the time (Negative Predictive Value).
Conclusion: TT and its modification, the TTS can guide evaluation and management of palpable breast masses in AKUH. A TT result merits further evaluation with a tru-cut biopsy. A prospective study that validates the concept and further improves the results will be appropriate.
Kahie, A. A. (2008). Triple test assessment and a scoring system to predict the presence of breast cancer at Aga Khan University Hospital, Nairobi (Unpublished master's dissertation). .