"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)
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.
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.
- No lesion detected
- Benign lesion
- Probably benign lesion
- Probably malignant lesion
- Definitely malignant lesion
Reports are given as:
- Inadequate. The reason for the 'inadequcy' may due to a number of factors include the procedure and subsequent preparation of the slide.
- Benign. Implies technically good sample with sufficient normal cells.
- 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.
- 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
- Malignant. Cells diagnostic of malignancy.
- Benign breast tissue
- Equivocal, probably benign
- Suspicious, probably malignant
- ↑ Guidelines for non-operative diagnostic procedures and reporting in breast cancer screening. NHSBSP Publication No 50, Jun 2001. ISBN 1 87 1997 44 5