Quadruple score: A novel scoring system for diagnosing breast lump – A retrospective pilot study

Background: Triple test was a breakthrough in the initial screening of breast cancer due to its high sensitivity, but it has few limitations. To overcome those limitations, we developed a novel quadruple score which included physical examination, ultrasound, mammography, and fine-needle aspiration cytology (FNAC). Aim: The aim of this study was to test the sensitivity, specificity, negative predictive value (NPV), and positive predictive value of a novel quadruple score for the initial screening of breast cancer. Methodology: This retrospective study was conducted on 320 patients having breast lump to the Breast Cancer Outpatient Department of AIIMS, Bhopal. The physical examination findings, breast sonography findings, mammography, and FNAC findings were recorded in the set pro forma, these were later analyzed, and a cumulative scoring was done categorizing patients in the benign, dubious, and malignant category according to the QTS score. These findings were then validated and compared by histopathology. Results: Statistical results show a positive covariance σ suggesting the positive relation between them; also, the correlation coefficient was 0.9996 suggesting a strong linear correlation. On comparing the accuracy of all four variables as physical examination, USG, mammography and FNAC individually and QTS, the accuracy of QTS was highest i.e 99.44%. Conclusion: QTS is accurate and reliable diagnostic approach for evaluation of breast lumps. By using the quadruple scoring system, management of palpable breast lump will become more streamlined, providing a platform for managing discordant results, which can be followed universally.