43 The first of Corniche in Maadi Cairo,Egypt



Triple Assessment

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
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

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.

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