Effect of state anxiety on sleep-wake cycle in mice / 中国药理学通报

Aim To observe the effect of state anxiety on the sleep-wake cycle of mice in the Triple test.Methods Eighteen male ICR mice were selected, and the electroencephalogram(EEG)and electromyogram(EMG)electrodes were embedded in the cortex and neck muscles of the mice under the conditions of anesthesia.There was a continuous 24 h tracing of mice under normal conditions after the recovery period.The model replication and behavioral evaluation of the state anxiety took place in the Triple test and the mouse sleep for 24 h was recorded for 7 consecutive days after the daily test.Results The behavioral evaluation showed that compared with 1st d, the time spent in central and% time in OF on 3 ?4 ?5 ?7 d of modeling was significantly reduced(P<0.05; P<0.01); the number of entries and% time of 4-7 d in EPM signifi-cantly increased(P<0.01); 2nd and 4th day of time spent in dark compartment of LDB increased significantly(P<0.05; P<0.01).The results of EEG analysis showed that compared with the sleep-wake cycle under normal conditions, the sleep and wake cycles had undergone significant changes, and the awakening time and its proportion were significantly prolonged(P<0.05; P<0.01), NREM sleep and its proportion markedly decreased on the 1-5 and 7 d(P<0.05; P<0.01), and a significant increase occurred in REM sleep and its proportion on 1st, 2nd, and 4th day(P<0.05).Conclusion The sleep-wake cycle of state anxiety mice replicated with the Triple test changes, and the impact on daytime sleep is more obvious.

A prospective study to determine the accuracy of triple test score in breast lump

Background: Breast cancer is the most common cancer in women worldwide. The commonest mode of presentation of diseases of the breast is lump. It is the most common site-specific cancer in women. Triple test score which includes clinical breast examination, mammogram, FNAC score. A simple non-invasive but reliable test can make a huge difference in management between benign and malignant lumps. Aims and objectives of the study were to differentiate between benign and malignant lesions based on TTS and correlated the accuracy of triple test score with histopathology report, and plan the management accordingly.Methods: A prospective study was carried out in which TTS was calculated by summation of individuals’ scores of all three components and compare with histopathology report.Results: In present study of 74 patients (age group of 30 to 65 years), based on TT score 52 benign, 12 malignant, and 10 suspicious (neither benign nor malignant). But the final histopathological result showed 59 as benign and 15 as malignant, which is in concordant with TTS, which shows the accuracy of up to 100%. Out of 10 (suspicious) which were dis-concordant, 7 are benign and 3 are malignant on histopathology.Conclusions: By use of the triple test score and its interpretation, definitive treatment can be initiated, which would reduce the need for unnecessary biopsy and its ability to predict benign lump, can avoid major surgery.

Study of clinical, imaging and pathological assessment of breast lumps: an observational study

Background: A palpable lump in a woman’s breast could be benign or malignant and it requires prompt evaluation to confirm or exclude cancer. This study aims to establish the correlation between clinical and radiological parameters for provisional diagnosis of breast lumps and the role of histopathology for final diagnosis of these breast lumps.Methods: Total 275 female patients with palpable breast lumps were included in the study, where a detailed history was recorded and clinical examination was done. All patients underwent ultrasonography of the breast along with fine needle aspiration cytology or histopathology, wherever indicated.Results: Benign breast lumps were found more commonly in 18-30 years of age group whereas malignant breast lumps were seen more commonly in the 41-60 years age group and the incidence increased with age. Fixity to skin was present in 5.1% and fixity to chest wall was present in 5.8% respectively, and all of these cases turned out to be malignant.Conclusions: Attributing factors for suspicion of malignant lumps are advanced age, fixity to surrounding structures, presence of ulceration and peau’d orange breast skin appearance. Although for confirmation of malignancy from a suspected breast lump requires either cytology or histopathology of the excised specimen.

Determination of gene action for yield and its related traits in soybean under North-Western Himalayas conditions of India

Aim: To understand the nature and magnitude of gene action for yield and its related traits in soybean.Methodology: Fifty four triple test cross progenies developed by crossing 18 lines with three testers Him soya and Hara soya (P1 and P2) and their F1s were used as testers ‘L1’,’L2’ and ‘L3’. F1 seeds were produced by crossing Him soya with Hara soya during kharif 2011. By crossing these three testers with 18 lines (females), 54 triple test cross hybrids were developed during kharif 2012. The fifty four F1 hybrids along with 18 lines and 3 testers were sown during kharif 2013 in a randomized block design with three replications. Results: In the triple test cross progenies, sufficient genetic variations were found for all the traits, except petiole length. Epistasis was observed to be an integral part of genetic variations for traits like plant height, branches per plant, nodes on main stem, internode length, pods per plant, pod length, biological yield per plant, seed yield per plant, oil content, crude protein content. Epistatic interaction for most traits was additive x dominance and dominance x dominance (j+l) type. In addition to additive x dominance and dominance x dominance (j+l), additive x additive (i) type epistasis was observed for plant height, internode length, pods per plant and biological yield per plant. For the inheritance of most traits, fixable type of gene action was found as additive component (D), was more pronounced than dominance component (H), except pod length. Interpretation: For improvement of traits, selection in the early generations will be useful as additive gene action was observed. The importance of additive x dominance (j) and dominance x dominance (l) type of epistasis in the inheritance of seed yield and other related traits signifying the importance of recurrent selection in order to develop high yielding varieties. For pod length, both additive and dominant components were observed. Thus genetic improvement in seed yield would be easier through indirect selection for pod length.

To Correlate The Modified Triple Test (MTT) For Palpable Breast Mass With Histopathology.

Discrete breast mass in young women are common cause of anxiety though majority of these lesion are benign.It is frightful experience for the patient to undergo invasive procedure i.e. biopsy of breast mass. So there is obvious need of such diagnostic tool which is noninvasive or minimally invasive, quick , reliable , equivalent or nearly equivalent to current existing diagnostic procedure to avoid unnecessary biopsy, reduce patients anxiety and cost effective.Aims and objective–To study the role of modified triple test in the diagnosis of palpable breast mass.Material and method- The study was a prospective study done in tertiary care center Dehradun from June 2017 to June 2018. It was carried out in the department of surgery in SGRRIM and HS and included 148 patients who presented with palpable breast mass. Patients who were already diagnosed case of carcinoma breast were excluded from the study. Thorough clinical examination of breast was done. All the patients were investigated firstly by sonomammography then FNAC.Either core biopsy or excisional biopsy of breast mass was done in all the cases. Findings were recorded and data analysis was done. Sonomammography report was recorded according BIRADS protocol besides giving probable diagnosis. Breast mass histopathology (HPE) report was considered to be gold standard and all the results were compared with HPE of the same breast mass.Result: results of MTT is comparable with histopathology of the same breast mass. Conclusion: modified triple test is sufficient and reliable investigation for diagnosing palpable breast mass and biopsy of breast mass should be reserved only for doubtful cases.

Prenatal Screening for Congenital Defects birth / Монголын Анагаах Ухаан

The double and triple test is a prenatal screening used to identify those pregnant women who shouldbe offered a diagnostic test to identify whether their fetus has an aneuploidy. It was first described in1988, but has largely been superseded by newer tests either conducted earlier in the first trimester(ie, the combined test, using ultrasound measurement of nuchal translucency, pregnancy-associatedplasma protein A, and human chorionic gonadotrophin [hCG]) or in the second trimester (ie, thetriple and quadruple test, using α-fetoprotein, hCG, uE3, and inhibin).These newer tests have been introduced because they offer greater detection and lower screenpositive results thereby enhancing diagnosis rates, while decreasing the risk of iatrogenic harmcaused by the invasive testing required when collecting suitable sample tissue. Both first andsecond trimester screening programs have been expanded to include risk assignment for trisomy18. Targeted screening algorithms have not been developed for chromosomal abnormalities otherthan Down syndrome and trisomy 18, although it has been suggested that a trisomy13 risk might becalculated. The construction of such algorithms would require recognition of a characteristic patternfor each condition using the appropriate combination of markers. It is likely, therefore, that the doubleand triple test will continue to be used in routine antenatal care for the foreseeable future.

The Evaluation of Integrated Test as an Antenatal Screening Test for Down's Syndrome in Korea

BACKGROUND: Antenatal screening for Down's syndrome has been developed and improved over the past 20 yr. Recently, integrated test, which combines the first and second trimester markers has shown the highest detection rate (DR) and lowest false positive rate (FPR) among Down's syndrome screening tests currently in use. The purposes of this study were to evaluate the screening performance of integrated test and to compare the results with triple test studies in Korea. METHODS: The study population consisted of Korean pregnant women who underwent triple or integrated test between April 2005 and December 2008. Triple test was performed using measurements of alpha-fetoprotein (AFP), unconjugated estriol (uE3), and human chorionic gonadotropin (hCG) in the second trimester. Integrated test was performed using nuchal translucency (NT) by ultrasonography and pregnancy-associated plasma protein A (PAPP-A) from maternal serum in the first trimester, and AFP, uE3, hCG, and inhibin-A in the second trimester. The screening performance of each test was evaluated by DR and FPR. RESULTS: Twenty-seven Down's syndrome pregnancies were confirmed in women screened by triple (N=6,736) or integrated test (N=7,688). At 1:100, 1:270, and 1:300 of risk cutoff, triple test showed 45%, 73%, and 73% of DR and 4.7%, 11.2%, and 12.4% of FPR, respectively. At 1:100, 1:150, and 1:300 of risk cutoff, integrated test showed 63%, 69%, and 75% of DR and 1.5%, 1.9%, and 3.0% of FPR, respectively. CONCLUSIONS: Integrated test showed higher DR and lower FPR, demonstrating better screening performance than triple test.

Korean-Specific Parameter Models for Calculating the Risk of Down Syndrome in the Second Trimester of Pregnancy

The purpose of the current study was to propose a Korean-specific parameter set for calculating the risk of Down syndrome in the second trimester of pregnancy and to determine the screening performances of triple and quadruple tests in Korean women. Using the data on triple or quadruple screening from three hospitals in Korea during 7 yr, we re-converted the concentrations of four serum markers to multiple of median values according to gestational age and maternal weight. After re-calculating the risk of Down syndrome in each pregnancy by multiplying maternal age-specific risk by the likelihood ratio values for the serum markers, screening performances and optimal cut-off values of triple and quadruple tests were analyzed. Among 16,077 pregnancies, 23 cases had Down syndrome (1.4/1,000 deliveries). Compared to the previous program, the tests with new parameters had improved screening performance. The triple and quadruple tests had detection rates of 65.2% and 72.7%, respectively, at a false-positive rate of 5%. The optimal cut-off value for the quadruple and triple tests was 1:250. We have presented a Korean-specific parameter set for Down syndrome screening. The proposed screening test using this parameter set may improve the performance of Down syndrome screening for Korean women.

Comparación de cribado combinado (ecográfico y bioquímico) de cromosomopatías en el primer y segundo trimestre de gestación en el hospital Teodoro Maldonado Carbo, Guayaquil – Ecuador / Combined cribation (echographic and biochemical) comparison of chromosomal pathologies in pregnancy first and second quarters in Teodoro Maldonado Carbo hospital, Guayaquil – Ecuador

Tipo de estudio: prospectivo, observacional, longitudinal. Objetivo general: comparar los hallazgos ecográficos con los del triple test como métodos de tamizaje para diagnóstico prenatal en mujeres de alto riesgo. Metodología: pacientes gestantes escogidas al azar ≥ 35 años atendidas en el área materno infantil del hospital “Teodoro Maldonado Carbo” del IESS, durante el período comprendido entre diciembre 2006 a mayo de 2007. Se les realizó a las 11-14 semanas de gestación (SG) el tamizaje ecográfico para cromosomopatías. Durante las 15 - 20 semanas el estudio bioquímico (triple test) en el laboratorio Medilabsa. A las 18 – 22 SG se les repitió el tamizaje ecográfico para cromosomopatías para confirmar resultados. Resultados: de las 31 pacientes valorados los productos obtenidos fueron: un aborto espontáneo a las 16.4 SG, (3.22); dos pacientes presentaron productos con Síndrome de Down, (6.25), primer producto reportó durante la valoración de la ecografía del primer trimestre TN > 3mm, Triple test positivo riesgo 1:50, ecografía 3D presentó inserción baja de la oreja, sexo masculino; segundo producto reportó en la ecografía del primer trimestre TN 3.2mm, ductus venoso invertido, triple test positivo, riesgo 1:30. Eco 3D presentó inserción baja de las orejas, atresia duodenal, comunicación interauricular. Conclusiones: combinado ambos tamizajes (primer y segundo trimestre) para el diagnóstico de cromosomopatías, se presenta un mejor perfil de eficacia, seguridad y costo-eficiencia. Mediante ambos métodos no invasivos, inocuos, sin riesgos para el binomio madre – feto y poseen una amplia aplicación clínica.

Study type: prospective, observational, and longitudinal. General objective: to compare echographic findings with those of the triple test as cribation methods for prenatal diagnosis in high risk women. Methodology: pregnant patients randomly chosen≥35 years old seen in the maternal-infantile area of the “Teodoro Maldonado Carbo” IESS hospital from december/2006 to may/2007. At 11th-14th pregnancy weeks (PW) echographic cribation for chromosomal pathologies . At 15-20 weeks biochemical study (triple test) in Medilabsa laboratory. At 18-22 PW the echographic cribation for chromosomal pathologies was made once again to confirm results. Results: out of 31 assessed patients: one spontaneous abortion at PW 16.4 (3.22); two Down’s Syndrome (6.25), the first one in the 1st. quarter echography showed NT > 3mm, positive risk 1:50 triple test; 3D echography showed low insertion of the ear, male. The second one showed in 1st quarter echography NT > 3.2mm, inverted venous ductus, positive,risk 1:30 triple test; 3D echography showed low insertion of the ears, duodenal atresia, atrial septum defect. Conclusions: making a combination of both cribations (1st and 2nd quarters) for diagnosing chromosome pathologies, we have more efficiency, safety and better cost-benefit. Both methods are non invasive, innocuous, risk free for mother as well as for fetus and are extensively applied as a clinical procedure.

Midtrimester triple test in IVF/ICSI twin pregnancies / 대한산부인과학회지

OBJECTIVE: To compare the midtrimester triple marker levels for down syndrome screening between natural and IVF twin pregnancies and to evaluate the difference triple marker in IVF twin pregnancies according to the fertilization method and number of transferred embryos. METHODS: The study population consisted of conventional IVF twin (n=106), ICSI twin (n=142), and natural (n=436) twin pregnancies as controls between 2001 and 2004. All pregnancies in this study were known to have normal outcome. Maternal serum samples were collected between 14-18 gestational weeks. Levels of AFP, total hCG, and uE3 were measured and were expressed as multiples of the median (MoM) based on reference medians established at Cheil Hospital. RESULTS: The mean maternal age (31.6+/-2.8 vs. 31.6+/-3.0 vs. 32.1+/-2.1: conventional IVF group vs. ICSI group vs. control, respectively) and gestational weeks (16.0+/-0.5 vs. 16.0+/-0.7 vs. 16.1+/-0.2) for triple test were similar. There was no difference in levels of all serum markers between conventional IVF and ICSI group. The median AFP MoM for conventional IVF and ICSI group were significantly higher than that of the control group (2.40 vs. 2.22 vs. 1.98; p0.05). Also, the median hCG MoM was not different from that of the control group (2.04 vs. 2.06 vs. 2.02; p>0.05). There was no correlation in triple marker levels according to the number of transferred embryos in conventional IVF and ICSI groups. CONCLUSION: Midtrimester triple marker levels of IVF twin pregnancy for down syndrome screening are similar with those of natural twin pregnancy regardless of fertilization method and number of transferred embryos.

The Utility of Modified Triple Test for Preoperative Diagnosis of Breast Diseases / 한국유방암학회지

PURPOSE: The number of people who visit outpatient departments for a self-examination, health examination or an examination about breast disease has recently been increasing. Among these peoples, some of them have abnormal finding for their breasts, and several diagnostic methods are presently being used for the accurate diagnosis of these patients. In this study, we wished to increase the diagnosis rate of breast disease and we wanted to create the opportunity for obtaining accurate diagnosis by using mammography, ultrasonography and fine needle aspiration biopsy. METHODS: From January 2000 to December 2002, 127 patients among all the patients who visited department of surgery, were clinically assessed with using ultrasonography, mammography, fine needle aspiration biopsy and postoperative histopathology after they had first undergone excisional biopsy. We had calculated the sensitivity, specificity, the positive predictive value, the negative predictive value and the diagnostic accuracy of each diagnostic method. We assigned points for the diagnostic result and we then calculated the sensitivity and specificity via these points. RESULTS: The sensitivity of ultrasonography, mammography and fine needle aspiration biopsy was 94.9%, 82.1% and 94.9%, respectively, and the specificity was 62.5%, 90.9% and 93.2%, respectively. The positive predictive value was 52.9%, 80% and 86.0%, and the negative predictive value was 96.5%, 92% and 97.6%, and the diagnostic accuracy was 72.4%, 88.2% and 93.7%, respectively. We divided the results by the benign and malignant nature of the findings with using points, and on this triple test, the sensitivity was 97.4%, the specificity was 97.7%, the positive predictive value was 95%, the negative predictive value was 98.9% and the diagnostic accuracy was 97.6%. CONCLUSION: When diagnosing breast disease, the modified triple test showed that it reduce the rate of performing unnecessary surgical operations. Good skilled technique when performing fine needle aspiration biopsy can help to future reduce this rate even more.

Cytogenetic Analysis in 651 Cases of Amniocentesis / 대한진단검사의학회지

BACKGROUND: The purpose of this study was to analyze the cytogenetic results of amniocentesis in terms of patients' ages and indications. It was further intended to examine the temporal trend in amniocentesis indications for cytogenetic analysis. METHODS: A total of 651 cases of amniocentesis were examined at Masan Samsung Hospital dur-ing the period 1996 to 2001 and were used to analyze the age distribution, indications, and chromo-somal results in relationship to maternal age and with the indication for amniocentesis. RESULTS: The overall rate for chromosomal abnormalities was 3.8% (25 out of 651 cases). In addi-tion, the 25-29 age group fell into the most common age distribution group with 261 from 651 amnio-centesis cases (40.1%). It turned out that the abnormal triple test for alpha-fetoprotein (AFP), the human chorionic gonadotropin (hCG), and the unconjugated estriol (nE3 ) were the most common indications for amniocentesis (51.4%), and 3.9% (13 out of 335 cases) showed chromosomal abnormalities. Among 25 cases of chromosomal abnormalities, 18 cases were numerical and 7 cases were struc-tural abnormalities. In 18 cases of numerical abnormalities, there were 12 Down syndrome cases, 4 Edwards syndrome cases, 1 Patau syndrome case and 1 Turner syndrome case. In 7 cases of struc-tural abnormalities, there were 6 cases of reciprocal translocation and 1 case of Robertsonian translo-cation. CONCLUSIONS: A primary indication for cytogenetic analysis in mid-trimester amniocentesis appeared as an abnormal triple test. Although such triple tests were effective enough in detecting chromoso-mal abnormalities in fetuses, it increased unnecessary amniocentesis. It is proposed that a new technique for non-invasive prenatal diagnosis for chromosomal abnormalities with a sufficient detection rate and a low false positive rate (such as analysis of fetal nucleated red blood cells from maternal blood) should be introduced.

Evaluation of Nonconcordant Triple Test That Influences on Accurate Diagnosis of Breast Mass

PURPOSE: "Triple tests" have been employed to provide an accurate diagnosis of breast mass. The triple test consists of TTm (physical examination, mammogram, and fine needle aspiration cytology (FNA)) and TTs (physical examination, ultrasonography, and FNA). We undertook the present study to determine the accuracy and usefulness of the triple test in case of concordant and nonconcordant elements. METHODS: Five hundred and six patients who visited our center with palpable breast mass from January 1990 to December 1999 were subjected to all three components of the triple test. The breast masses were listed as either benign, suspicious or malignant. Results of the triple test were analyzed as concordant or nonconcordant. All patients underwent subsequent open biopsy. RESULTS: As 278 cases of TTm and 185 cases of TTs were found to be concordant, pathologic analysis of open biopsy determined a sensitivity of 98%, and 100%, a specificity of 99%, and 99%, a positive predictive value of 98%, and 97%, negative predictive value of 99%, and 100%, and an accuracy of 99%, and 99%, respectively. FNA was the most reliable element of the triple test in cases where three elements of the test were nonconcordant. In cases where a suspicious or malignant FNA result was accompanied by a suspicious or malignant result of mammogram or ultrasonography, the FNA false positive rate was 0%. In 160 cases of nonconcordant TTm, 83 were malignant and 77 were benign. The malignant cases of nonconcordant TTm were 10 (13%) when a single test was suspicious or malignant, 32 (64%) when two tests were suspicious or malignant, and 35 (100%) when all three tests were suspicious or malignant. In 112 cases of nonconcordant TTs, 59 were malignant and 53 were benign. The malignant cases of nonconcordant TTs were 7 (11%) when a single test was suspicious or malignant, 16 (84%) when two tests were suspicious or malignant, and 30 (96%) when all three tests were suspicious or malignant. CONCLUSION: When all three elements of the triple test are concordant, an open biopsy for confirmation of palpable breast lesions is unnecessary. Futhermore, when the elements of the triple test are nonconcordant, we recommend definitive therapy without open biopsy only in cases where suspicious or malignant FNA results are accompanied by at least one other positive result the of the triple test.

Diagnosis of Palpable Breast Masses by the Modified Triple Test Score: A prospective study / 한국유방암학회지

PURPOSE: The modified triple test (MTT; physical examination, ultrasonography, and fine-needle aspiration cytology) for palpable breast masses yielded 100% diagnostic accuracy when all 3 components were concordant (all benign or all malignant) in our previous study. However, about 30% of cases were discordant and required open or core needle biopsy. This study is designed to evaluate the modified triple test by scoring system, based on our experience, and to develop a method to further limit the need for surgical biopsy of discordant cases. METHODS: The MTT was performed in 175 palpable breast masses of 166 female patients between August 1998 and June 2001 at the Outpatient Clinic, Department of Surgery, Chungbuk National University Hospital. Each component of the MTT was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total modified triple test score (MTTS) from 3 to 9 points, and 25 cases with 3 points of MTTS were clinically followed up without histological confirmation. RESULTS: Among 175 cases, concordant cases were 120 (68.6%); benign cases was 66 (37.7%), and malignant cases were 54 (30.8%). Concordant cases had 100% of diagnostic accuracy, sensitivity, and specificity. Among the 25 cases of benign concordant (MTTS 3 points), no case was proved to be malignant through clinical follow-up observation. Total discordant cases were 55 (31.4%); 15 cases of 4 points (8.6%), 11 cases of 5 points (6.3%), 4 cases of 6 points (2.3%), 18 cases of 7 points (10.3%), 7 cases of 8 points (4.0%). In each discordant group, 0 cases of 4 points (0%), 2 cases of 5 points (18.2%), 3 cases of 6 points (75%), 15 cases of 7 points (83.8%), and 7 cases of 8 points (100%) were proved to be malignant by histologic confirmation. Aspiration cytology has the highest specificity and positive predictive value of the 3 MTT components. CONCLUSION: Palpable breast masses that score 3 or 4 points by MTTS are benign and could be clinically followed up, and masses that score 8 or 9 points are malignant and should undergo defiitive therapy. Confirmatory biopsy might be applied on only 20% of the masses the reserve MMTTS of 5, 6, and 7 points.

Diagnosis of Palpable Breast Masses by the Modified Triple Test Score-A prospective study-

PURPOSE: The modified triple test (MTT; physical examination, ultrasonography, and fine-needle aspiration cytology) for palpable breast masses yielded 100% diagnostic accuracy when all 3 components were concordant (all benign or all malignant) in our previous study. However, about 30% of cases were discordant and required open or core needle biopsy. This study is designed to evaluate the modified triple test by scoring system, based on our experience, and to develop a method to further limit the need for surgical biopsy of discordant cases. METHODS: The MTT was performed in 175 palpable breast masses of 166 female patients between August 1998 and June 2001 at the Outpatient Clinic, Department of Surgery, Chungbuk National University Hospital. Each component of the MTT was assigned 1, 2, or 3 points for a benign, suspicious, or malignant result, respectively, yielding a total modified triple test score (MTTS) from 3 to 9 points, and 25 cases with 3 points of MTTS were clinically followed up without histological confirmation. RESULTS: Among 175 cases, concordant cases were 120 (68.6%); benign cases was 66 (37.7%), and malignant cases were 54 (30.8%). Concordant cases had 100% of diagnostic accuracy, sensitivity, and specificity. Among the 25 cases of benign concordant (MTTS 3 points), no case was proved to be malignant through clinical follow-up observation. Total discordant cases were 55 (31.4%); 15 cases of 4 points(8.6%), 11 cases of 5 points (6.3%), 4 cases of 6 points (2.3%), 18 cases of 7 points (10.3%), 7 cases of 8 points (4.0%). In each discordant group, 0 cases of 4 points (0%), 2 cases of 5 points (18.2%), 3 cases of 6 points (75%), 15 cases of 7 points (83.8%), and 7 cases of 8 points (100%) were proved to be malignant by histologic confirmation. Aspiration cytology has the highest specificity and positive predictive value of the 3 MTT components. CONCLUSION: Palpable breast masses that score 3 or 4 points by MTTS are benign and could be clinically followed up, and masses that score 8 or 9 points are malignant and should undergo defiitive therapy. Confirmatory biopsy might be applied on only 20% of the masses the reserve MMTTS of 5, 6, and 7 points.

Use of the Triple Test at the Breast Screening Center for Patients with Breast Mass

PURPOSE: Breast mass - the most common occurences in the breast must be managed by a method that provides both the best medical and cosmetic results. METHODS: Two hundred seventy-eight patients evaluated and managed for breast mass at our center between January 1998 and December 1999 were analysed. In this study, we compare the results of the triple test score (TTS; sum of physical examination, mammography, and fine needle aspiration cytology) with those from each separate diagnostic test according to a standard formula incorporating sensitivity, specificity, positive predictive value, and negative predictive value. The TTS was modified to substitute sonography for mammography-TTSs. The TTS was also compared to the TTS-2 that double weighted the results of fine needle aspiration (FNA), but was otherwise the same as the TTS. RESULTS: The sensitivity and specificity of breast sonography were 90% and 84% whereas those of mammography were 84% and 73%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the TTSm (triple test score-mammography) were 99%, 97%, 99% and 97% respectively. The scores of the TTSm-2 were 99%, 100%, 100% and 97%. And those of the TTSs were 100%, 100%, 100% and 100%. CONCLUSION: The TTS was more accurate than each of the elements separately in evaluating breast masses. The TTSs was also more effective than the TTSm. The TTS-2 was more useful than the TTS, being less likely to miss malignancy due to the high accuracy of FNA.

A Study on Modified Triple Test for Palpable Breast Mass: A prospective study

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USGand FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION: The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.

Use of the Triple Test for the Patients with Palpable Breast Masses / 한국유방암학회지

PURPOSE: Breast mass - the most common occurences in the breast must be managed by a method that provides both the best medical and cosmetic results. METHODS: Two hundred seventy-eight patients evaluated and managed for breast mass at our center between January 1998 and December 1999 were analysed. In this study, we compare the results of the triple test score (TTS; sum of physical examination, mammography, and fine needle aspiration cytology) with those from each separate diagnostic test according to a standard formula incorporating sensitivity, specificity, positive predictive value, and negative predictive value. The TTS was modified to substitute sonography for mammography-TTSs. The TTS was also compared to the TTS-2 that double weighted the results of fine needle aspiration (FNA), but was otherwise the same as the TTS. RESULTS: The sensitivity and specificity of breast sonography were 90% and 84% whereas those of mammography were 84% and 73%, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the TTSm (triple test score-mammography) were 99%, 97%, 99% and 97% respectively. The scores of the TTSm-2 were 99%, 100%, 100% and 97%. And those of the TTSs were 100%, 100%, 100% and 100%. CONCLUSION: The TTS was more accurate than each of the elements separately in evaluating breast masses. The TTSs was also more effective than the TTSm. The TTS-2 was more useful than the TTS, being less likely to miss malignancy due to the high accuracy of FNA.

A Study on Modified Triple Test for Palpable Breast Mass / 한국유방암학회지

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USG, and FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION:The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.

Prenatal Diagnosis of the Wolf-Hirschhorn Syndrome

Wolf-Hirschhorn syndrome (WHS) is caused by a deletion of the short arm on chromosome 4 and is characterized by multiple congenital abnormalities, growth and mental retardation. In this case report, we performed amniocentesis for the chromosome analysis on a 25-year-old pregnant woman at 16 weeks of gestation whom we suspected of Edward's syndrome by the triple test of maternal serum and ultrasonography. The result of analysis revealed a karyotype of the fetus with 46,XY,del(4)(p15) by trypsin Giemsa's banding technique. With the result, we were able to diagnose the fetus as having WHS. As such, after therapeutic termination of the pregnancy, we confirmed WHS through the sampling of tissue by both trypsin Giemsa's banding and fluorescence in situ hybridization (FISH) method. To determine the origin of the WHS, we further tested the karyotypes of the parents. As parental karyotypes were found to be normal, we determined the case of the fetal WHS to be de novo.