Triple assessment

From Ganfyd

"Triple assessment" describes the way a woman presenting or being recalled from screening with what may be breast cancer is assessed in a breast cancer service.

It consists of:

• Clinical examination
• Radiological assessment
• Pathological examintion (histology/cytology)

Clinical Examination

Along with the history, palpation of any suspected mass or for any lesion apparent from screening gives a clinical impression of a benign or malignant lesion.

Imaging

In older women, mammography provides good imaging of the breast. In younger women, the breast parenchyma is denser and ultrasound is the better modality. In case of doubt, another modality can be used as an adjunct. MRI is being increasingly used, but is not routine, in the UK in 2011. In the UK, shorthand is used to describe any lesion thus discovered (U=ultrasound detected, R or M=radiographically/mammographically detected). Outside the UK, the Bi-RADS classification is commonly used.

U1/R1

No lesion detected

U2/R2

Benign lesion

U3/R3

Probably benign lesion

U4/R4

Probably malignant lesion

U5/R5

Definitely malignant lesion

Pathological examination

The cellular structure of any lesion can be found by either cytology or histology (including core biopsy).

Reports are given as:^[1]

Cytology

C1 

Inadequate. The reason for the 'inadequcy' may due to a number of factors include the procedure and subsequent preparation of the slide.

C2 

Benign. Implies technically good sample with sufficient normal cells.

C3 

Atypia, probably benign. More subtle changes may be present that are not seen in benign cells, e.g. nuclear polymorphism, cell discohesivness, cell changes due to hormonal treatments.

C4 

Suspicious of malignancy. Highly abnormal features, but where the cytologist cannot be certain of malignant diagnosis due to:

• poor preservation/preparation
• malignant features despite no actual malignant cells
• overall benign pattern, but occasional cells with malignant features

C5 

Malignant. Cells diagnostic of malignancy.

Biopsy

B1

Normal

B2

Benign breast tissue

B3

Equivocal, probably benign

B4

Suspicious, probably malignant

B5

Malignant

References