The dread of cancer makes patients quite anxious when they discover a lump in their breast, which is one of the most prevalent clinical presentations in surgical practice. There are a variety of benign and malignant lesions that can be considered when diagnosing a lump in the breast [1, 2]. These include fibroadenomas, fibrocystic disease, and invasive carcinoma. In all cancer cases, but notably breast cancer—which is still the top cause of cancer-related mortality among women globally—an early and precise diagnosis is essential for prompt treatment, less morbidity, and better survival results [3, 4]. Clinical examination and histological evaluation after excision biopsy used to be the gold standard for diagnosing breast lumps. This method, however, has the risk of causing patients excessive anxiety, unneeded operations, and diagnostic delays. The Triple Assessment (TA) approach was developed to tackle these problems; it involves a combination of clinical examination, imaging, and cytological investigation to diagnose breast lesions quickly and accurately [5]. Using a scoring system called the Modified Triple Test Score (MTTS), which assigns a score of 1 to 3 to each component (clinical, imaging, and FNAC), the Modified Triple Assessment (MTA) takes this method a step further. Lesion classification as benign, suspected, or malignant is achieved by adding the three scores (from 3 to 9), which improves diagnostic accuracy and guides management options [6, 7]. Research indicates that when the three parts of the triple evaluation match, the diagnostic accuracy is close to 100%. This helps to distinguish between benign and malignant breast masses and decreases the necessity for invasive surgical biopsies. However, additional histological confirmation is required in cases when the results are contradictory [8]. When time is of the essence and money is tight, the Modified Triple Assessment shines as a non-invasive, quick diagnostic tool. It helps doctors efficiently classify breast lumps, so patients with benign lesions don't get treatments they don't need and those with cancer get the care they need quickly [9]. This prospective study aimed to compare the results of the Modified Triple Assessment with those of the gold standard, histopathological examination (HPE), in order to determine its accuracy, sensitivity, specificity, and predictive value in the diagnosis of breast masses.

This prospective observational study was conducted in the Department of General Surgery, Dr. Patnam Mahender Reddy Institute of Medical Sciences (PIMS), Chevella, Rangareddy, Telangana between October 2024 to Septeber 2025. A total of 50 female patients presenting with palpable breast lumps to the surgical outpatient department were enrolled after obtaining informed consent. Ethical clearance was obtained from the institutional ethics committee prior to commencement of the study. Inclusion Criteria:  Female patients aged ≥18 years presenting with palpable breast lumps.  Patients willing to undergo all three components of the Modified Triple Assessment. Patients who provided written informed consent for participation in the study. Exclusion Criteria:  Patients with previous history of breast surgery or malignancy.  Patients presenting with non-palpable lesions detected only on imaging.  Pregnant or lactating women, due to altered breast tissue characteristics.  Patients who refused or were unfit for further diagnostic or surgical procedures.  Inadequate or inconclusive FNAC or histopathology reports.

The current prospective investigation was performed on 50 female patients with palpable breast masses. We looked at the results of the clinical exam, imaging, FNAC, and histology to see how well the Modified Triple Assessment (MTA) can tell the difference between benign and malignant breast lesions. Table 1: Age-wise Distribution of Patients Age Group (years) No. of Patients Percentage (%) < 20 4 8.0 21–30 10 20.0 31–40 13 26.0 41–50 12 24.0 51–60 8 16.0 > 60 3 6.0 Total 50 100 Half of the patients were in the age group of 31 to 50, with an average age of 42.3 ± 10.2 years. The occurrence of cancer rose as women aged, whereas benign lesions were more common in women under the age of 40. Table 2: Distribution of Breast Lumps Based on Histopathological Diagnosis Histopathological Diagnosis No. of Patients Percentage (%) Fibroadenoma 18 36.0 Fibrocystic disease 10 20.0 Breast abscess/mastitis 4 8.0 Phyllodes tumor 4 8.0 Ductal carcinoma in situ (DCIS) 2 4.0 Invasive ductal carcinoma 10 20.0 Invasive lobular carcinoma 2 4.0 Total 50 100 According to histopathological analysis, benign lesions made up 72% of the cases and malignant lesions 28%. Fibroadenomas accounted for 36% of benign lesions, while invasive ductal carcinoma accounted for 20% of malignancies. Table 3: Correlation of MTA Components with Histopathology (n = 50) Component True Positive True Negative False Positive False Negative Sensitivity (%) Specificity (%) Accuracy (%) Clinical Examination 13 32 2 3 81.2 94.1 90.0 Imaging (USG/Mammography) 12 34 1 3 80.0 97.1 92.0 FNAC 13 35 1 1 92.8 97.2 96.0 Modified Triple Assessment 14 34 0 2 100.0 97.2 98.0 The diagnostic accuracy of the Modified Triple Assessment was good across the board, with FNAC demonstrating the highest reliability of any individual test at 96%. By combining its results, the MTA was able to distinguish between benign and malignant breast masses with a sensitivity of 100% and a specificity of 97.2%, for a total diagnostic accuracy of 98%. Table 4: Distribution of Patients Based on Modified Triple Test Score (MTTS) and Histopathological Correlation MTTS Category Score Range No. of Patients Histopathology – Benign (n=36) Histopathology – Malignant (n=14) Benign 3–4 34 33 1 Suspicious 5–6 6 3 3 Malignant 7–9 10 0 10 Total 3–9 50 36 14 Using the Modified Triple Test Score, 34 out of 50 patients were deemed benign, 6 as suspicious, and 10 as malignant. Using histopathological correlation, MTA was able to accurately identify 48 out of 50 cases, with just 1 false-negative case (2% of the total) and 1 suspicious case (2% of the total) misclassified. Therefore, the Modified Triple Test Score is a reliable diagnostic tool due to its high predictive accuracy.

A well-known method for checking for palpable breast cancers is the Modified Triple Assessment (MTA), which combines a physical exam with imaging and fine-needle aspiration cytology (FNAC). The purpose of this prospective study was to compare the diagnostic accuracy of MTA with that of the gold standard, histopathological examination (HPE), and to assess whether the results were significantly different. The study included 50 patients [10, 11]. In this study, Consistent with previous research showing that the majority of breast lesions arise in women throughout their reproductive and perimenopausal years, the majority of patients in this study (50%) were aged 31-50 years. We found that both benign and malignant breast disorders occur at younger ages in emerging countries, where the average age is 42.3 years, which is consistent with the trend observed in Western populations [12, 13]. In this study, the majority of cases (72% according to the histology results) were caused by benign breast diseases. After fibrocystic disease (20%), fibroadenoma (36% of cases) was the most common lesion. Consistent with previous research, fibroadenoma is still the most prevalent benign breast lesion in younger women (Tiwari, 2010; Bukhari et al., 2011). Consistent with findings from studies worldwide, 28% of the lesions were malignant, with invasive ductal carcinoma being the most frequent histologic subtype at 20% [14, 15]. In the previous study, by breaking down MTA into its component parts, the clinical test achieved a specificity rate of 94.1%, a sensitivity rate of 81.2%, and an accuracy rate of 90%. The first step is still a clinical evaluation, although the overlap in symptoms between benign and malignant tumors might limit its accuracy [16, 17]. With a sensitivity of 80% and a specificity of 97.1%, imaging (ultrasonography for individuals under 40 years old and mammography for those over 40 years old) achieved a diagnostic accuracy of 92%. The results obtained by Ariga et al. (2002), who also reported an accuracy rate of 89%, are comparable. Differentiating cystic from solid lesions was made much easier with the use of ultrasonography. In contrast, mammography was useful for detecting architectural deformation and microcalcifications in older women [18, 19]. Our study found that FNAC was 97.2% specific, had a sensitivity of 92.8 percent, and a diagnostic accuracy of 96.6 percent. This is in line with the results reported by Khemka et al. (2009) and Chaudhary et al. (2003), which indicated FNAC accuracies ranging from 92% to 98%. FNAC remains an easy, low-cost, and non-invasive way to get cytological findings quickly [20]. In the previous study, the Modified Triple Assessment was 98 percent accurate in making diagnoses, with a specificity of 97.2% and a sensitivity of 100 percent. This proves that the combined use of all three approaches significantly improves the accuracy of the diagnosis. This confirms what previous research by Mendivil et al. (2001) and Kumar et al. (2011) found: that when all three parts were in sync, the accuracy ranged from 95% to 100%. Only one case in our series was misclassified as benign on MTA but later diagnosed as malignant on histology, highlighting the need for further evaluation in cases when results are contradictory [21, 22]. In the previous study, one helpful tool for objectively classifying breast tumors was the Modified Triple Test Score (MTTS). Lesions were considered harmless with a score of 3–4, doubtful with a score of 5–6, and damaging with a score of 7–9. Based on our findings, this scoring approach was able to provide a firm diagnosis in 48 out of 50 cases (96%). It demonstrated a strong correlation with histology [23]. In settings with constrained resources, our findings further demonstrate the Modified Triple Assessment's efficacy as a sensitive, precise, and economical diagnostic tool. It is usually unnecessary to conduct open surgical biopsies when all three components are in agreement because the accuracy is nearly 100%. To avoid missing a diagnosis due to conflicting or questionable evidence, histological confirmation is essential [24].

The Modified Triple Assessment consists of clinical examination, imaging (ultrasonography/mammography), and fine-needle aspiration cytology (FNAC). This prospective study involving 50 patients with palpable breast lumps demonstrates that the MTA is an accurate, reliable, and cost-effective method for distinguishing benign from malignant breast lesions. Lastly, the Modified Triple Assessment should be used often to check for lumps in the breasts because it is a quick, straightforward, and effective way to diagnose them. It makes it possible to diagnose patients early and accurately, which reduces their worry, stops unnecessary operations, and makes it easier to manage patients. This is especially important in healthcare systems with limited resources. Funding None Conflict of Interest: None

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