The Triple Assessment - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x The triple assessment is a method used in breast clinic that allows for the early and rapid detection of breast cancer. Women (and men) can be referred to this ‘one stop’ clinic by their GP if they have signs or symptoms that meet the breast cancer “2 week wait” referral criteria, or if there has been a suspicious finding on their routine breast cancer screening mammography. The triple assessment aims to provide a quick and simple outpatient approach to diagnosis and allow for the early intervention in the treatment of breast cancer. History and Examination A detailed history and examination are performed by a breast surgeon. In the history, further to the clinical details of their presenting complaint, any potential risk factors are identified, including family history and current medications. The full breast examination is described here, however predominantly focuses around breast palpation and assessment of the axillary nodes. By Aimee Rowe, TeachMeSurgery [CC-BY-NC-ND 4.0] Figure 1The Stages of the Triple Assessment Imaging The mainstay of imaging during the triple assessment is based around either mammography or ultrasound investigations: Mammography involves compression views of the breast across two views (oblique and craniocaudal), allowing for the detection mass lesions or microcalcifications. Ultrasound scanning is more useful in women <35 years and in men, due to the density of the breast tissue in identifying anomalies. This form of imaging is also routinely used during core biopsies. MRI imaging is not used in the mainstay of triple assessment however can be useful in the assessment of lobular breast cancers (and in assessing response to neoadjuvant therapy); whilst it has high sensitivity, it has a low specificity. Histology A biopsy is required of any suspicious mass or lesion presenting to the clinic, most commonly obtained via core biopsy. A core biopsy provides full histology (as opposed to fine needle aspiration (FNA) which only provides cytology), allowing differentiation between invasive and in-situ carcinoma. The test can generate important information about tumour grading and staging, and has a higher sensitivity and specificity than FNA for detecting breast cancer. If a woman has recurrent cystic disease (and the lesion is clinically a cyst), this can be aspirated using FNA at this stage for cytology and to relieve symptoms. Differential Diagnosis At each stage of the triple assessment, the suspicion for malignancy is graded to create an overall risk index, as discussed below. The key here is to establish whether this is likely a benign lesion or whether the patient should go onto have more definitive biopsy and further intervention. Examination Score Imaging Score (Mammography (M), Ultrasound (U)) Histology Score P1 – Normal M1 / U1 – Normal B1 – Normal P2 – Benign M2 / U2 – Benign B2 – Benign P3 – Uncertain/likely benign M3 / U3 – Uncertain/likely benign B3 – Uncertain, probably benign P4 – Suspicious of malignancy M4 / U4 – Suspicious of malignancy B4 – Suspicious of malignancy P5 – Malignant M5 / U5 – Malignant B5 – Malignant Management From the clinical, radiological and pathological information gained about a breast lump at the Triple Assessment, a diagnosis of breast cancer can be made. The individual case will then be discussed at a Multi-Disciplinary Team (MDT) meeting where a treatment plan will be developed. Key Points The triple assessment comprises of the history + examination, imaging, and histology Each part of the assessment is combined for a case-by-case evaluation to the likely diagnosis Cases suspicious for breast cancer are discussed by the MDT to create a suitable treatment plan Do you think you’re ready? Take the quiz below Pro Feature - Quiz The Triple Assessment Question 1 of 2 Submitting... Skip Next Rate question: You scored 0% Skipped: 0/2 Keep your streak going Unlock the full question bank You’ve made a great start. Continue with over 1,200 MRCS-style MCQs, two full mock papers, and ad-free revision with TeachMeSurgery Pro. Continue with Pro Frequent questions What is the purpose of the triple assessment in breast clinics? The triple assessment is designed to facilitate the early detection of breast cancer through a streamlined outpatient process. It combines history taking, imaging, and histology to provide a rapid diagnosis and enable timely treatment intervention. What types of imaging are used in the triple assessment? The primary imaging modalities in the triple assessment are mammography and ultrasound. Mammography is effective for detecting mass lesions and microcalcifications, while ultrasound is preferred for younger women and men due to denser breast tissue. How is histological analysis performed during the triple assessment? Histological analysis is conducted through a core biopsy of any suspicious lesion, which provides detailed information about tumour characteristics. This method is more sensitive and specific than fine needle aspiration, allowing for differentiation between invasive and in-situ carcinoma. What factors are considered during the history and examination phase of the triple assessment? During the history and examination phase, a breast surgeon gathers clinical details and identifies potential risk factors, including family history and current medications. A thorough breast examination focuses on palpation and assessment of axillary nodes. How is a diagnosis made following the triple assessment? A diagnosis of breast cancer is established based on the combined clinical, radiological, and pathological findings obtained during the triple assessment. Cases with suspected malignancy are reviewed in a Multi-Disciplinary Team meeting to formulate an appropriate treatment plan. Rate This Article