Diagnostic Pathways

Abstract

Evaluation of breast cases is based on the principle of “triple assessment” involving a combination of clinical examination, imaging, and tissue biopsy. This yields an overall accuracy of almost 100% and permits the majority of patients attending “one-stop” clinics to be reassured and discharged without further follow-up. There is much overlap in the clinical features of benign and malignant breast conditions, and physical examination alone has limited accuracy. This underscores the principle of triple assessment in which clinical examination is complemented by radiological imaging with or without some form of tissue biopsy. A review of almost 7000 patients undergoing “triple assessment” within one of the author’s unit revealed an accuracy of 99.6% with only 0.4% of cases representing a “missed diagnosis” on retrospective review. Patients present to breast clinics with a range of symptoms but two-thirds will have either a lump or an area of lumpiness (nodularity).