INTRODUCTION Breast diseases are increasing in incidence and prevalence due to the advances in diagnostic techniques and chronicity of the disease. Breast lumps unless and other wise proved as benign are a nightmare for both the patients and the surgeons. Therefore proper easy and early detection of malignancies of the breast is the need of the hour. Since the incidence of carcinoma breast amongst younger women is in an increasing trend especially less than 40 ,child bearing productive age groups, the diagnosis of carcinoma breast plays a major role even with respect to social and national importance. A triple test of clinical examination, mammogram and ultrasound study of breast was being carried out with a fair amount of success rates. But there are not cases that have not been missed by this triple test. So in order to improve our diagnostic standards, from non invasive to invasive mode of investigation but yet a simple and outpatient basis procedure was incorporated in to this system of screening test . This is now to be called as modied triple test. Aims And Objectives Earlier detection of malignancy in breasts with the aid of modied triple test which includes clinical examination, USG breast, FNAC of breast lump. MATERIALS AND METHODS A prospective study of 103 patients were included in the study. A proper ethical clearance and informed written consent was obtained from the individuals subjected to the study. Inclusion criteria included Female > 20yrs and willing for lump excision. Exclusion criteria included females<20 yrs, males, Advanced diseases of breast, patients not willing for lump excision RESULTS Patients were clinically radiologically and by Aspiration cytology from breast lump were evaluated. They were taken up for excision and biopsy surgery. postoperatively HPE report was compared with the preoperative diagnosis and the effectiveness of modied triple test was studied. Fig 1 surgical method Fig 2 HPE report Table 1 Hpe Report Table 2 Axillary Lymphnodes In Relation With Hpe Report P VALUE-0.001 Table 3 Fnac Report In Relation With Hpe Report A STUDY ON EARLY DETECTION OF BREAST LUMPS MALIGNANCIES BY MODIFIED TRIPLE TESTS Original Research Paper General Surgery Introduction: Breast diseases are at a rising trend in recent years among young women. Many cancers are diagnosed at advanced stages. Carcinoma breast that too invasive ductal variety is the most commonest of all. Aims and objectives: Earlier detection of malignancy in breasts with the aid of modied triple test which includes clinical examination USG breast, FNAC of breast lump. Materials and methods: A prospective study of 103 patients were included in the study. Inclusion criteria- Female > 20yrs and willing for lump excision. Exclusion criteria- females <20 yrs,males, Advanced diseases of breast, patients not willing for lump excision. Results: Based on the studies 17 /20 of nipple discharge cases ,30/50 painless lumps,19/21 axillary lymphnode cases,33/39 hard lumps were malignant. sensitivity of USG ,clinical examination, FNAC,MTT 86.8% ,86.34% 92% ,97.36% respectively. Conclusion: Modied triple test is far better in early detection of breast malignancies than individual tests ABSTRACT KEYWORDS : Breast, clinical examination, FNAC, Malignancy, Ultrasonography VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr. Upendra Kumar Rajendra Institute Of Medical Sciences Ranchi, Jharkhand -834009 Dr. Milandeep* Guru Gobind Singh Medical College, Faridkot, Punjab-151203 *Corresponding Author Dr. Gajendra Pandit Rajendra Institute Of Medical Sciences Ranchi, Jharkhand -834009 Prof. Dr. Sudhir Khichy Guru Gobind Singh Medical College, Faridkot, Punjab-151203 Prof. Dr. R. S. Sharma Rajendra Institute Of Medical Sciences Ranchi, Jharkhand -834009 HPE-BENIGN HPE-MALIGNANT NO.OF PATIENTS 65 38 PERCENTAGE 38 36.9% HPE-BENIGN HPE-MALIGNANT AXILLARY LYMPHNODE + 2 19 AXILLARY LYMPHNODE - 63 19 HPE- BENIGN HPE- MALIGNANT FNAC + FOR MALIGNANCY 0 33 52 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS P VALUE -0.001 Table 4 Usg Report In Relation With Hpe Report P VALUE -0.001 Table 6 Mtt Results P VALUE -0.001 Table 7 Mtt Statistics Table 5 Comparison Of Sensitivity And Specicity Of Each Of The Tests With All In Combination DISCUSSION Based on the above results it can be concluded that that a combination of different types of evaluating methods confers a greater advantage in terms of diagnostic accuracy and saves valuable time with respect ot commencement of treatment for malignant cases. Clinical criteria suggestive of malignancy such as painless lump, hardness of lump, nipple retraction, xed axillary node involvement, peau-d-orange appearance of skin xity of the lump can not be taken up for conrmation of malignancy. Similarly breast lumps assessed by USG in the grades of BIRADS are also at risk of being missed for malignancy when done alone. More invasive procedure like FNAC can be relied upon with comparative credibility but exceptions in that too are there at times. A combination of all factors in the diagnosis of a cancer breast is more reliable since the results are commanding its accuracy. The triple test was initially described in the mid-1970s, by Johansen C. as the evaluation of palpable breast masses by physical examination, mammography, and FNAC. The Triple test has proved a reliable tool for the accurate diagnosis of palpable breast masses, due to its technical simplicity, and resulted in substantially reduced expense and morbidity compared with open surgical biopsy.[5] Due to the reduced sensitivity and specicity of lesion detection by mammography in young women under 40 and the usefulness of sonography in this group of patients, researchers dealing with women under 40 combined sonography with mammography to the scoring system and the modied TTS was introduced which is an integration of clinical breast examination, sonography and FNA.[10] The TTS reliably guides evaluation and treatment of breast lesions. Lesions scoring 3 or 4 are always benign. Lesions with scores ≥6 are malignant and should be treated accordingly. Conrmatory biopsy is required only for the lesions that receive a TTS of 5. CONCLUSION At present the modied triple test is a well developed tool that can , with fair amount of success be used for early detection of carcinoma breast at younger age groups their by avoiding life long morbidity and mortality. This eld is evolving day by day and the means to detect wide spread metastasis cannot be picked up by this test. There are many hormonal and receptor assays that are creeping into practice to REFERENCES [1]. Chopra R. The Indian scene. J Clin Oncol. 2001;19:106S–11. [PubMed] [2]. Pant I, Singh PK, Singh SN, Agarwal A, Singh NB. Cyto morphological study of palpable breast lesion and histopathologic correlation. J Cytol. 2003;20:129–32. [3]. Meena SP, Hemrajani DK, Joshi N. A comparative and evaluative study of cytological and histological grading system prole in malignant neoplasm of breast — An important prognostic factor. Indian J Pathol Microbiol. 2006;49:199–202. [4]. Lester SC. The breast. In: Kumar V, Abbas AK, Aster JC, Fausto N, editors. 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[PMC free article] VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra FNAC – FOR MALIGNANCY 59 1 INCONCLUSIVE 6 2 HPE-BENIGN HPE-MALIGNANT USG + FOR MALIGNANCY 0 33 USG – FOR MALIGNANCY 60 0 INCONCLUSIVE 5 5 MTT HPE MALIGNANT HPE BENIGN MALIGNANT 37 0 BENIGN 1 65 SENSITIVITY 97.36% SPECIFICITY 100% POSITIVE PREDICTIVE VALUE 100% NEGATIVE PREDICTIVE VALUE 98.48% TEST SENSIT IVITY SPECIFI CITY +PREDICIT VE VALUE -PREDICITI VE VALUE CLINICAL EXAMINATION 86.34% 91% 85% 84.42% USG BREAST 86.84% 100% 100% 92.86% FNAC 92.10% 100% 100% 95.58% MODIFIED TRIPLE TEST 97.36% 100% 100% 98.48% X 53GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS