Added Value of Fine-Needle Aspiration (FNA) or Breast Magnetic Resonance Imaging (MRI) as Part of the "Triple Test" to Assess Palpable Abnormalities on a Breast Exam With Negative Imaging Findings.

Abstract

When a breast abnormality is palpated on a clinical breast exam in the setting of negative imaging (mammography and/or sonography), fine-needle aspiration (FNA) or magnetic resonance imaging (MRI) often is performed as part of the "triple test" to rule out malignancy. Because the negative predictive value (>97 %) of modern breast imaging is high, we hypothesized that additional evaluation with FNA and MRI adds little diagnostic value. This study queried institutional databases to identify patients with negative breast imaging who underwent MRI or FNA for evaluation of a palpable breast abnormality on a clinical breast exam (2009-2023). For 83 patients with 89 palpable abnormalities, the mean age was 48 years (interquartile range [IQR], 22.75 years). Two (2.4 %) of the patients had concurrent breast cancer. Of the 89 masses, 67 (75.3 %) underwent FNA only, 19 (21.3 %) underwent MRI only, and 3 (3.4 %) underwent FNA and MRI. The FNA findings were benign in 42 (60 %) cases, nondiagnostic in 25 (35.7 %) cases, atypical in 3 (4.3 %) cases, and malignant in 0 % cases. All MRIs were negative for an imaging correlate. For 12 masses, surgery was performed (11 excisional biopsies, 1 incisional biopsy), and all surgical pathology results were benign. During a median follow-up period of 6.6 years, no patients developed malignancy at the site of palpable abnormality, and six patients (7.2 %) developed breast cancer at other sites. For women with palpable abnormalities and negative imaging, upgrade to malignancy with FNA or MRI was 0 %. We concluded that FNA or MRI as part of the "triple test" is a low-value intervention. Patients with a palpable breast abnormality may be safely followed with interval imaging.