Triple Assessment
Diagnosis has to be as follows:
1- Clinical examination by a specialist.
2- Mammography and/or Ultrasound examination.
3- A special needle sample taken and send for microscopic examination. Fine needle is inferior with low reliability.
1- Clinical examination by a specialist:
Is really needed as 15% of malignant tumors might not show on
mammograms hence, examination is necessary.
2- Mammography:
Is suitable for ladies over the age of 35, but not so under 35 as in the
young, the breasts are too dense for mammogram reading.
3- Ultrasound (sonar):
Suits well those under 35.
Complements Mammography, if there is an abnormality.
Could well differentiate between a solid and fluid filled lesion (cyst).
4- Histology Examination (Biopsy):
A special needle biopsy (core biopsy under local anaesthesia) is
mandatory.
Histology – Estrogen and Progesteron and Her2 receptors. (Er,Pr,Her2)
Fine needle sample carries unacceptably high false negative rates and
cannot differentiate between various types of tumors.
Surgical excision should be prohibited (without a prior needle biopsy)
and refused (accepted in very rare cases).
Surgical biopsy deprives the patient of the optimal management plan,
should be refused.
5- Magnetic Resonance imaging – MRI:
Is needed is special situations, for example:
a) Still diagnostic uncertainty/ discrepancy between clinical and
radiological assessment.
b) If actual extent of the disease cannot be properly assessed
otherwise – ?multiple masses – the very young.
c) Screening the very young with family history of the disease.
d) Invasive Lobular Cancer and the patient is keen on preserving
the Breast.
e) Paget`s disease 9if the patient is keen on breast preservation.
f) The very dense breast.
g) Suspected implant leak
6- PET mammo:
is a very new technique with very promising
results and capable of diagnosing tumours as small as 1.6
millimeters.
7- CT Scan:
Is not needed in making the initial diagnosis but, might be needed after
diagnosis in planning the best management, :
I. Tumors larger than 5cm (T3)
II. Fixed tumors. (T4)
III. More than 3 Lymph Nodes involved.
IV. Inflammatory cancer.
V. Abnormal Liver function.
VI. High risk on final histology report.
No Surgical definitive surgery should be allowed without prior, full assessment.
