suman kharkwal | GGSIPU - Academia.edu (original) (raw)

Papers by suman kharkwal

Research paper thumbnail of Aggressive angiomyxoma of vulva: a rare and interesting entity

International Surgery Journal, Oct 29, 2022

Aggressive angiomyxoma (AA) is a rare mesenchymal tumor which is found usually in females during ... more Aggressive angiomyxoma (AA) is a rare mesenchymal tumor which is found usually in females during their reproductive age. Steeper and Rosai first described AA in their 1983 case series as a rare, slow-growing and locally infiltrative neoplasm with a tendency for recurrence. 1 Due to the infiltrative nature of the tumor and frequent local recurrence, it is termed as aggressive. The World Health Organization defines AAM as a "tumor of uncertain differentiation" with approximately 350 known cases till date. 2 It is often misdiagnosed as a abscess, Bartholin gland cyst, or lipoma. 3 Microscopically, sections showed many walled vessels of various sizes, a loose myxoid and collagenous stroma and stellate and spindle-shaped neoplastic cells. Immunohistochemically, the neoplastic cells showed strong positivity for vimentin and desmin and moderate positivity for CD34 and hormone receptors for estrogen and progesterone. 4

Research paper thumbnail of Assessment of the efficacy and safety of methylene blue dye for sentinel lymph node mapping in early breast cancer with clinically negative axilla

Archives of International Surgery, 2014

Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clin... more Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clinically negative axillary nodes are now well established. SLN biopsy has been performed using different techniques including injection of isosulfan blue dye (IBD), radioactive colloid, and methylene blue. The aim of this study was to assess the safety and efficacy of methylene blue dye (MBD) as a mapping agent for SLN biopsy in axillary node negative breast carcinoma. Materials and Methods: Between February 2010-2012, a total of 27 female patients of 18 years and above, with established diagnosis of breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied. After induction of anesthesia, 5 ml of 1% methylene blue was infiltrated into the subareolar tissue on the affected side. The lymph nodes receiving the blue dye were excised as the SLN. Modified radical mastectomy (MRM) was completed and the excised breast with the axillary tissue was sent for histopathological examination to correlate with the findings of the SLN biopsy. Results: The incidence of breast cancer was highest at 41-50 years. Of 27 cases, SLN was identified in 24 cases using MBD. The identification rate was 88.9%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 81.8, 100, 100, and 86.7%, respectively. Conclusion: This study confirms the safety and efficacy of methylene blue as a mapping agent for SLN biopsy in axillary node negative breast cancer.

Research paper thumbnail of Amyands Hernia: Report of Two Cases

Journal of case reports, Jul 30, 2014

Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a ... more Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a exceedingly rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be normal or inflamed and acute appendicitis is seen in 0.13% of cases. We hereby report two cases of Amyands hernia which were treated at ESI hospital PGIMSR, Delhi highlighting the fact that rather than simply being an anatomical curiosity, Amyands hernias require individualized attention to decide how to manage both the appendix and the hernia. First case was admitted in emergency as strangulated hernia. Inflamed appendix was noted intraoperatively as hernial content for which appendectomy and herniotomy was done. Our second case was worked up as routine case of right congenital hernia and after seeing the content of hernia sac as appendix, appendix was pushed back and herniotomy was done.

Research paper thumbnail of Aggressive angiomyxoma of vulva: a rare and interesting entity

International Surgery Journal

We report a case of a 44-year-old female with aggressive angiomyxoma arising from right labia maj... more We report a case of a 44-year-old female with aggressive angiomyxoma arising from right labia majora. The patient presented with a gradually enlarging vulvar mass and was treatment included wide local excision of the mass with R0 resection. Pre operative and final histopathology was consistent with features of aggressive angiomyxoma. Angiomyxoma is a rare, benign, locally infiltrative mesenchymal tumor that occurs in females at reproductive age. Repeated recurrence and locally invasive characteristics of the tumor makes it important to be considered as a part of the differential diagnosis especially in cases of pelvic mass in females.

Research paper thumbnail of Cerebellopontine angle tumour in a case of metastatic carcinoma breast: a diagnostic dilemma

International Surgery Journal, May 26, 2022

Tumours of the cerebellopontine angle are mostly vestibular schwannomas with metastasis being a r... more Tumours of the cerebellopontine angle are mostly vestibular schwannomas with metastasis being a rare diagnosis. But, metastasis if present, are usually from a breast or a lung primary. We presented a case of a 67 year old postmenopausal lady with luminal. A carcinoma left breast who developed a recurrence on aromatase inhibitor with bone metastasis. She also presented with a cerebellopontine angle tumour which, because of its unusual presentation, presence of a recurrent breast disease with metastasis and mutation testing, raised the suspicion of a brain metastasis but was finally confirmed to be a vestibular schwannoma by histopathology.

Research paper thumbnail of Rare clinical entity- Fibroadenoma of ectopic breast tissue

A 34 year old female presented with bilateral axillary masses, of 1 year duration. The masses exh... more A 34 year old female presented with bilateral axillary masses, of 1 year duration. The masses exhibited similar consistency to adjacent breast tissue but lacked an associated nipple complex. The clinical impression was lipoma;however mammography and ultrasonography revealed ectopic breast tissue with fibroadenoma. Ectopic breast tissue(EBT) may constitute a diagnostic challenge and is often misdiagnosed as lipoma,follicular cyst or lymphadenopathy.In addition, some studies have suggested that ectopic breast tissue may be at higher risks of malignant degeneration. Therefore it’s important that physicians be familiar with this condition as this may contribute to the early detection of ectopic breast cancer.

Research paper thumbnail of Amyands Hernia: Report of Two Cases

Journal of Case Reports, 2014

Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a ... more Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a exceedingly rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be normal or inflamed and acute appendicitis is seen in 0.13% of cases. We hereby report two cases of Amyands hernia which were treated at ESI hospital PGIMSR, Delhi highlighting the fact that rather than simply being an anatomical curiosity, Amyands hernias require individualized attention to decide how to manage both the appendix and the hernia. First case was admitted in emergency as strangulated hernia. Inflamed appendix was noted intraoperatively as hernial content for which appendectomy and herniotomy was done. Our second case was worked up as routine case of right congenital hernia and after seeing the content of hernia sac as appendix, appendix was pushed back and herniotomy was done.

Research paper thumbnail of Assessment of the efficacy and safety of methylene blue dye for sentinel lymph node mapping in early breast cancer with clinically negative axilla

Archives of International Surgery, 2014

Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clin... more Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clinically negative axillary nodes are now well established. SLN biopsy has been performed using different techniques including injection of isosulfan blue dye (IBD), radioactive colloid, and methylene blue. The aim of this study was to assess the safety and efficacy of methylene blue dye (MBD) as a mapping agent for SLN biopsy in axillary node negative breast carcinoma. Materials and Methods: Between February 2010-2012, a total of 27 female patients of 18 years and above, with established diagnosis of breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied. After induction of anesthesia, 5 ml of 1% methylene blue was infiltrated into the subareolar tissue on the affected side. The lymph nodes receiving the blue dye were excised as the SLN. Modified radical mastectomy (MRM) was completed and the excised breast with the axillary tissue was sent for histopathological examination to correlate with the findings of the SLN biopsy. Results: The incidence of breast cancer was highest at 41-50 years. Of 27 cases, SLN was identified in 24 cases using MBD. The identification rate was 88.9%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 81.8, 100, 100, and 86.7%, respectively. Conclusion: This study confirms the safety and efficacy of methylene blue as a mapping agent for SLN biopsy in axillary node negative breast cancer.

Research paper thumbnail of Clinical Profile and Management of Oral Cancer; Is Tobacco Ban the Need of the Hour? An ESIC Tertiary Care Hospital Experience

International Journal of Head and Neck Surgery

In this scheme, the employee's contribution rate is 0.75% of the wages, and that of the employer'... more In this scheme, the employee's contribution rate is 0.75% of the wages, and that of the employer's is 3.25% of the wages paid/payable in respect of the employees in every wage period, and though the contributions are based on the workers IntroductIon Oral cancer is one of the commonest cancers in India, and as per the Globocan 2020 data, it is the most common cancer among Indian males and the second most common cancer in both sexes. 1 Though curable if detected in early stages and also easily accessible by virtue of site for examination, both by a patient as well as healthcare worker, most patients reach in locally advanced and late stages, leading to complex management protocols, poorer treatment outcomes, and increasing health care burden. 2 Most common risk factor is tobacco usage. 3-5 In India, rampant usage of various forms of smokeless tobacco like khaini, gutkha is the leading risk factor, others being alcohol consumption, low socioeconomic status, and lack of oral hygiene. This retrospective study was conducted in a tertiary care hospital and medical college and hospital of ESIC, which is a social security system aimed at the labor class population of India with a budget of 80,000 crore INR (US $11 billion). This scheme is one of the biggest social security providers in the world and is designed to provide socioeconomic protection to employees in the organized sector, with the provision of medical benefits being its major strength. As the monthly wage ceiling for coverage of an employee 1-3

Research paper thumbnail of Metachronous metastasis of renal cell carcinoma to bilateral testis

Journal of Cancer Metastasis and Treatment, 2015

Research paper thumbnail of Medullary Thyroid Cancer with Normal Serum Calcitonin and Tubercular Neck Nodes: A Rare and Challenging Presentation

World Journal of Endocrine Surgery

We report a highly unusual case of medullary carcinoma thyroid with normal serum calcitonin and t... more We report a highly unusual case of medullary carcinoma thyroid with normal serum calcitonin and tuberculous lymphadenitis mimicking metastatic neck nodes. A 26-year-old married woman was diagnosed with sporadic medullary carcinoma of thyroid on fine needle aspiration cytology (FNAC). Preoperative ultrasonography (USG) and contrast-enhanced computed tomography (CECT) neck suggested a metastasis in level IIB neck nodes. Patient underwent total thyroidectomy with central neck dissection with right modified neck dissection type III. Final histopathological report revealed medullary carcinoma thyroid (MTC) with tubercular lymphadenitis, none of 47 nodes retrieved had metastasis. She remains disease free after 2 years following surgery.

Research paper thumbnail of Triple Test in Carcinoma Breast

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014

The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnos... more The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of "TRIPLE TEST"in diagnosis of carcinoma breast in rural labour class population. The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4(th) decade) followed by 27.5% in 51-60 years age group (5(th) decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value. TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.

Research paper thumbnail of Aggressive angiomyxoma of vulva: a rare and interesting entity

International Surgery Journal, Oct 29, 2022

Aggressive angiomyxoma (AA) is a rare mesenchymal tumor which is found usually in females during ... more Aggressive angiomyxoma (AA) is a rare mesenchymal tumor which is found usually in females during their reproductive age. Steeper and Rosai first described AA in their 1983 case series as a rare, slow-growing and locally infiltrative neoplasm with a tendency for recurrence. 1 Due to the infiltrative nature of the tumor and frequent local recurrence, it is termed as aggressive. The World Health Organization defines AAM as a "tumor of uncertain differentiation" with approximately 350 known cases till date. 2 It is often misdiagnosed as a abscess, Bartholin gland cyst, or lipoma. 3 Microscopically, sections showed many walled vessels of various sizes, a loose myxoid and collagenous stroma and stellate and spindle-shaped neoplastic cells. Immunohistochemically, the neoplastic cells showed strong positivity for vimentin and desmin and moderate positivity for CD34 and hormone receptors for estrogen and progesterone. 4

Research paper thumbnail of Assessment of the efficacy and safety of methylene blue dye for sentinel lymph node mapping in early breast cancer with clinically negative axilla

Archives of International Surgery, 2014

Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clin... more Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clinically negative axillary nodes are now well established. SLN biopsy has been performed using different techniques including injection of isosulfan blue dye (IBD), radioactive colloid, and methylene blue. The aim of this study was to assess the safety and efficacy of methylene blue dye (MBD) as a mapping agent for SLN biopsy in axillary node negative breast carcinoma. Materials and Methods: Between February 2010-2012, a total of 27 female patients of 18 years and above, with established diagnosis of breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied. After induction of anesthesia, 5 ml of 1% methylene blue was infiltrated into the subareolar tissue on the affected side. The lymph nodes receiving the blue dye were excised as the SLN. Modified radical mastectomy (MRM) was completed and the excised breast with the axillary tissue was sent for histopathological examination to correlate with the findings of the SLN biopsy. Results: The incidence of breast cancer was highest at 41-50 years. Of 27 cases, SLN was identified in 24 cases using MBD. The identification rate was 88.9%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 81.8, 100, 100, and 86.7%, respectively. Conclusion: This study confirms the safety and efficacy of methylene blue as a mapping agent for SLN biopsy in axillary node negative breast cancer.

Research paper thumbnail of Amyands Hernia: Report of Two Cases

Journal of case reports, Jul 30, 2014

Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a ... more Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a exceedingly rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be normal or inflamed and acute appendicitis is seen in 0.13% of cases. We hereby report two cases of Amyands hernia which were treated at ESI hospital PGIMSR, Delhi highlighting the fact that rather than simply being an anatomical curiosity, Amyands hernias require individualized attention to decide how to manage both the appendix and the hernia. First case was admitted in emergency as strangulated hernia. Inflamed appendix was noted intraoperatively as hernial content for which appendectomy and herniotomy was done. Our second case was worked up as routine case of right congenital hernia and after seeing the content of hernia sac as appendix, appendix was pushed back and herniotomy was done.

Research paper thumbnail of Aggressive angiomyxoma of vulva: a rare and interesting entity

International Surgery Journal

We report a case of a 44-year-old female with aggressive angiomyxoma arising from right labia maj... more We report a case of a 44-year-old female with aggressive angiomyxoma arising from right labia majora. The patient presented with a gradually enlarging vulvar mass and was treatment included wide local excision of the mass with R0 resection. Pre operative and final histopathology was consistent with features of aggressive angiomyxoma. Angiomyxoma is a rare, benign, locally infiltrative mesenchymal tumor that occurs in females at reproductive age. Repeated recurrence and locally invasive characteristics of the tumor makes it important to be considered as a part of the differential diagnosis especially in cases of pelvic mass in females.

Research paper thumbnail of Cerebellopontine angle tumour in a case of metastatic carcinoma breast: a diagnostic dilemma

International Surgery Journal, May 26, 2022

Tumours of the cerebellopontine angle are mostly vestibular schwannomas with metastasis being a r... more Tumours of the cerebellopontine angle are mostly vestibular schwannomas with metastasis being a rare diagnosis. But, metastasis if present, are usually from a breast or a lung primary. We presented a case of a 67 year old postmenopausal lady with luminal. A carcinoma left breast who developed a recurrence on aromatase inhibitor with bone metastasis. She also presented with a cerebellopontine angle tumour which, because of its unusual presentation, presence of a recurrent breast disease with metastasis and mutation testing, raised the suspicion of a brain metastasis but was finally confirmed to be a vestibular schwannoma by histopathology.

Research paper thumbnail of Rare clinical entity- Fibroadenoma of ectopic breast tissue

A 34 year old female presented with bilateral axillary masses, of 1 year duration. The masses exh... more A 34 year old female presented with bilateral axillary masses, of 1 year duration. The masses exhibited similar consistency to adjacent breast tissue but lacked an associated nipple complex. The clinical impression was lipoma;however mammography and ultrasonography revealed ectopic breast tissue with fibroadenoma. Ectopic breast tissue(EBT) may constitute a diagnostic challenge and is often misdiagnosed as lipoma,follicular cyst or lymphadenopathy.In addition, some studies have suggested that ectopic breast tissue may be at higher risks of malignant degeneration. Therefore it’s important that physicians be familiar with this condition as this may contribute to the early detection of ectopic breast cancer.

Research paper thumbnail of Amyands Hernia: Report of Two Cases

Journal of Case Reports, 2014

Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a ... more Amyand's hernia, defined as an inguinal hernia with appendix as the content of hernial sac, is a exceedingly rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be normal or inflamed and acute appendicitis is seen in 0.13% of cases. We hereby report two cases of Amyands hernia which were treated at ESI hospital PGIMSR, Delhi highlighting the fact that rather than simply being an anatomical curiosity, Amyands hernias require individualized attention to decide how to manage both the appendix and the hernia. First case was admitted in emergency as strangulated hernia. Inflamed appendix was noted intraoperatively as hernial content for which appendectomy and herniotomy was done. Our second case was worked up as routine case of right congenital hernia and after seeing the content of hernia sac as appendix, appendix was pushed back and herniotomy was done.

Research paper thumbnail of Assessment of the efficacy and safety of methylene blue dye for sentinel lymph node mapping in early breast cancer with clinically negative axilla

Archives of International Surgery, 2014

Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clin... more Background : The benefits of sentinel lymph node (SLN) biopsy in breast cancer patients with clinically negative axillary nodes are now well established. SLN biopsy has been performed using different techniques including injection of isosulfan blue dye (IBD), radioactive colloid, and methylene blue. The aim of this study was to assess the safety and efficacy of methylene blue dye (MBD) as a mapping agent for SLN biopsy in axillary node negative breast carcinoma. Materials and Methods: Between February 2010-2012, a total of 27 female patients of 18 years and above, with established diagnosis of breast carcinoma with clinically negative ipsilateral axillary lymph nodes were studied. After induction of anesthesia, 5 ml of 1% methylene blue was infiltrated into the subareolar tissue on the affected side. The lymph nodes receiving the blue dye were excised as the SLN. Modified radical mastectomy (MRM) was completed and the excised breast with the axillary tissue was sent for histopathological examination to correlate with the findings of the SLN biopsy. Results: The incidence of breast cancer was highest at 41-50 years. Of 27 cases, SLN was identified in 24 cases using MBD. The identification rate was 88.9%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 81.8, 100, 100, and 86.7%, respectively. Conclusion: This study confirms the safety and efficacy of methylene blue as a mapping agent for SLN biopsy in axillary node negative breast cancer.

Research paper thumbnail of Clinical Profile and Management of Oral Cancer; Is Tobacco Ban the Need of the Hour? An ESIC Tertiary Care Hospital Experience

International Journal of Head and Neck Surgery

In this scheme, the employee's contribution rate is 0.75% of the wages, and that of the employer'... more In this scheme, the employee's contribution rate is 0.75% of the wages, and that of the employer's is 3.25% of the wages paid/payable in respect of the employees in every wage period, and though the contributions are based on the workers IntroductIon Oral cancer is one of the commonest cancers in India, and as per the Globocan 2020 data, it is the most common cancer among Indian males and the second most common cancer in both sexes. 1 Though curable if detected in early stages and also easily accessible by virtue of site for examination, both by a patient as well as healthcare worker, most patients reach in locally advanced and late stages, leading to complex management protocols, poorer treatment outcomes, and increasing health care burden. 2 Most common risk factor is tobacco usage. 3-5 In India, rampant usage of various forms of smokeless tobacco like khaini, gutkha is the leading risk factor, others being alcohol consumption, low socioeconomic status, and lack of oral hygiene. This retrospective study was conducted in a tertiary care hospital and medical college and hospital of ESIC, which is a social security system aimed at the labor class population of India with a budget of 80,000 crore INR (US $11 billion). This scheme is one of the biggest social security providers in the world and is designed to provide socioeconomic protection to employees in the organized sector, with the provision of medical benefits being its major strength. As the monthly wage ceiling for coverage of an employee 1-3

Research paper thumbnail of Metachronous metastasis of renal cell carcinoma to bilateral testis

Journal of Cancer Metastasis and Treatment, 2015

Research paper thumbnail of Medullary Thyroid Cancer with Normal Serum Calcitonin and Tubercular Neck Nodes: A Rare and Challenging Presentation

World Journal of Endocrine Surgery

We report a highly unusual case of medullary carcinoma thyroid with normal serum calcitonin and t... more We report a highly unusual case of medullary carcinoma thyroid with normal serum calcitonin and tuberculous lymphadenitis mimicking metastatic neck nodes. A 26-year-old married woman was diagnosed with sporadic medullary carcinoma of thyroid on fine needle aspiration cytology (FNAC). Preoperative ultrasonography (USG) and contrast-enhanced computed tomography (CECT) neck suggested a metastasis in level IIB neck nodes. Patient underwent total thyroidectomy with central neck dissection with right modified neck dissection type III. Final histopathological report revealed medullary carcinoma thyroid (MTC) with tubercular lymphadenitis, none of 47 nodes retrieved had metastasis. She remains disease free after 2 years following surgery.

Research paper thumbnail of Triple Test in Carcinoma Breast

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014

The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnos... more The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of "TRIPLE TEST"in diagnosis of carcinoma breast in rural labour class population. The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, India. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4(th) decade) followed by 27.5% in 51-60 years age group (5(th) decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value. TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.