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Triple assessment

Triple assessment is the combination of clinical, radiological, and pathological evaluation of a breast lesion (Table 2.1). Triple assessment should be used in all patients with a suspected breast lump and may be relevant in those with other symptoms. Imaging assessment consists of mammography (in those aged 35 years or over), and ultra-sonography is recommended for all palpable and significant radiological abnormalities (at any age). Histological assessment usually involves core biopsy and/or fine needle aspiration (FNA) cytology. This combination of techniques increases the reliability of determining the cause of a clinical or image-detected abnormality (Tables 2.2, 2.3). It is recommended that all elements of the assessment process are reported on a scale of 1-5 with increasing concern of malignancy. In a patient with a discrete breast mass or abnormality seen on imaging, some centres offer immediate reporting of imaging and cytology of fine needle aspirates or touch preparation cytology from a core biopsy. 'One stop' clinics have advantages for women with benign lumps who can be reassured and discharged after a single visit but are only likely to be cost effective in centres seeing large patient volumes.

Table 2.1Scoring system for triple assessment
Table 2.2*Accuracy of investigations in symptomatic breast clinic
Table 2.3Symptoms and cancer risk in those attending a symptomatic clinic

Clinical history

A history is taken from the patient of the duration and nature of presenting symptoms. Further specific details of individual symptoms are of value and are outlined below. Past personal or familial breast problems should be elucidated. General factors such as past medical history, drugs, and allergies should be recorded. Hormonal risk factors for cancer such as age of menarche and menopause, parity, age of first birth, breast feeding, oral contraceptive or hormone replacement therapy use are traditionally documented, although they are of ...

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