False Negative Tests in Breast Cancer: A Case Report

Main Article Content

Yi Xuan Lee


Background: Breast cancer is the most common cancer worldwide. An early and accurate diagnosis is essential in optimizing the disease outcome. Triple assessment which includes clinical assessment, imaging and pathological examination is recommended for diagnosing breast cancer.

The Case: A 43-year-old lady with a strong family history of cancer presented with a right breast lump for 2 months. Physical examination revealed a 2x3 cm mass in the right breast with no malignancy features. Mammogram and ultrasound revealed BI-RADS 1 (negative) and BI-RADS 2 (benign) respectively. A lumpectomy was done, and the sample was sent for pathological examination. The result came back as a grade 2 invasive breast carcinoma, no special type, stage pT1b. ER was negative while PR and HER2 were not tested. The patient then underwent right total mastectomy with level II axillary clearance. CT thorax, abdomen & pelvis was scheduled a month later to complete the cancer staging. PR and HER2 status were tested for further management.

Conclusion: All 3 components of triple assessment is indispensable for diagnosing breast cancer. Despite the high sensitivity of imaging modalities, minimally invasive biopsy technique (MIBT) is still the gold standard. False-negative tests can happen due to multiple factors; they should not become the absolute guidance for further management of patients. A doctor’s clinical judgement, based on thorough history taking and physical examination, is more important in guiding the next step of patient care.

Key Words: Breast Neoplasms, Mammography, Ultrasonography, Biopsy

Article Details

How to Cite
Lee, Y. X. (2023) “False Negative Tests in Breast Cancer: A Case Report”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia, 10(1). Available at: https://jamsa.amsa-international.org/index.php/main/article/view/415 (Accessed: 21May2024).
Case Report
Author Biography

Yi Xuan Lee, The National University of Malaysia

5th-year Medical Student, The National University of Malaysia (UKM).


Cancer [Internet]. Who.int. 2022 [cited 13 March 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer

Breast cancer [Internet]. Who.int. 2022 [cited 13 March 2022]. Available from: https://www.who.int/news-room/fact-sheets/detail/breast-cancer

Ministry of Health Malaysia. Management of Breast Cancer (Third Edition) [Internet]. [Putrajaya]: MOH Malaysia; 2019 [cited 13 March 2022]. (Clinical Practice Guidelines [MOH/P/PAK/432.19(GU)-e]). Available from: http://www.acadmed.org.my

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: Globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021;71(3):209–49.

Chavan SG, Vemuri N. Diagnosis of breast lumps based on breast imaging reporting and data system score and histopathological examination: a comparative study. International Surgery Journal. 2019 Dec 26;7(1):144-9.

da Costa Vieira RA, Biller G, Uemura G, Ruiz CA, Curado MP. Breast cancer screening in developing countries. Clinics. 2017;72:244-53.

F. Cardoso, S. Kyriakides, S. Ohno, F. Penault-Llorca, P. Poortmans, I. T. Rubio, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2019 Jun 4;(30):1194–1220

Febles G. False negatives in mammography. Revista De Imagenologia. 2013 Jun 10;16(2)

Chan C, Coopey S, Freer P, Hughes K. False-negative rate of combined mammography and ultrasound for women with palpable breast masses. Breast Cancer Research and Treatment. 2015;153(3):699-702.

Sood R, Rositch AF, Shakoor D, Ambinder E, Pool KL, Pollack E, et al. Ultrasound for breast cancer detection globally: a systematic review and meta-analysis. Journal of global oncology. 2019 Aug;5:1-7.