Skip to main content

Advertisement

SpringerLink
Log in

Mammography and ultrasound in the evaluation of male breast disease

  • Breast
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To assess clinical variables that may be useful in differentiating gynaecomastia from carcinoma and to analyse the contribution of mammography and ultrasound to the evaluation of male breast disease.

Methods

All men who underwent mammography and/or ultrasound between 1993 and 2006 in our hospital were retrospectively evaluated. Clinical characteristics in patients with gynaecomastia and those with carcinoma were compared. Radiological findings were classified according to the BI-RADS (Breast Imaging Reporting and Data System) criteria. The diagnostic performance of physical examination, mammography and ultrasound was determined and compared.

Results

A total of 628 patients with 518 mammograms and 423 ultrasounds were reviewed. The final diagnoses were: 19 carcinomas, 526 gynaecomastias, 84 other benign conditions and 25 normal. There were statistically significant differences in age, bilateral involvement, clinical presentation and physical examination between patients with carcinoma and those with gynaecomastia. The diagnostic performance of physical examination was lower than that of mammography and ultrasound (p < 0.05 for specificity). Mammography was the most sensitive (94.7%) and ultrasound the most specific (95.3%) for detection of malignancy (p > 0.05). We propose an algorithm for the use of mammography and ultrasound in men.

Conclusions

Mammography and ultrasound, with a negative predictive value close to 100%, make it possible to avoid very many unnecessary surgical procedures in men.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Braunstein GD (2007) Clinical practice: gynecomastia. N Engl J Med 357:1229–1237

    Article  CAS  PubMed  Google Scholar 

  2. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN (2004) Breast carcinoma in men. Cancer 101:51–57

    Article  PubMed  Google Scholar 

  3. Appelbaum AH, Evans GFF, Levy KR, Amirkhan RH, Schumpert TD (1999) Mammographic appearances of male breast disease. Radiographics 19:559–568

    CAS  PubMed  Google Scholar 

  4. Volpe CM, Raffetto JD, Collure DW, Hoover EL, Doerr RJ (1999) Unilateral male breast masses: cancer risk and their evaluation and management. Am Surg 65:250–253

    CAS  PubMed  Google Scholar 

  5. American College of Radiology (2003) Breast imaging reporting and data system atlas (BI-RADS Atlas), 4th edn. American College of Radiology, Reston

    Google Scholar 

  6. So GJ, Chantra PK, Wollman JS, Bassett LW (1997) The male breast. In: Bassett LW, Jackson VP, Jahan R, Fu YS, Gold RH (eds) Diagnosis of diseases of the breast, 1st edn. Saunders, Philadelphia, pp 501–518

    Google Scholar 

  7. Stewart RAL, Howlett DC, Hearn FJ (1997) Pictorial review: the imaging features of male breast disease. Clin Radiol 52:739–744

    Article  CAS  PubMed  Google Scholar 

  8. Sarteschi M, Turchi P, Paoli R, Sabo C, Massei A, Massei P, Menchini Fabris GF (1993) Echography aspects of gynecomastia. Arch Ital Urol Androl 65:331–335

    CAS  PubMed  Google Scholar 

  9. Cooper RA, Gunter BA, Ramamurthy L (1994) Mammography in men. Radiology 191:651–656

    CAS  PubMed  Google Scholar 

  10. Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, Bassett LW (2006) Imaging characteristics of malignant lesions of the male breast. Radiographics 26:993–1006

    Article  PubMed  Google Scholar 

  11. Dershaw DD (1986) Male mammography. AJR Am J Roentgenol 146:127–131

    CAS  PubMed  Google Scholar 

  12. Evans GFF, Anthony T, Turnage RH, Schumpert TD, Levy KR, Amirkhan RH, Campbell TJ, Lopez J, Appelbaum AH (2001) The diagnostic accuracy of mammography in the evaluation of male breast disease. Am J Surg 181:96–100; Published correction appears in Am J Surg 2001; 181:579

    Article  CAS  PubMed  Google Scholar 

  13. Kapdi CC, Parekh NJ (1983) The male breast. Radiol Clin North Am 21:137–148

    CAS  PubMed  Google Scholar 

  14. Crichlow RW, Galt SW (1990) Male breast cancer. Surg Clin N Am 70:1165–1177

    CAS  PubMed  Google Scholar 

  15. Patterson SK, Helvie MA, Aziz K, Nees AV (2006) Outcome of men presenting with clinical breast problems: the role of mammography and ultrasound. Breast J 12:418–423

    Article  PubMed  Google Scholar 

  16. Vetto J, Schmidt W, Pommier R, DiTomasso J, Eppich H, Wood W (1998) Accurate and cost-effective evaluation of breast masses in males. Am J Surg 175:383–387

    Article  CAS  PubMed  Google Scholar 

  17. Ambrogetti D, Ciatto S, Catarzi S, Muraca MG (1996) The combined diagnosis of male breast lesions: a review of a series of 748 consecutive cases. Radiol Med 91:356–359

    CAS  PubMed  Google Scholar 

  18. Simmons RM (2002) Male ductal carcinoma in situ presenting as bloody nipple discharge: a case report and literature review. Breast J 8:112–114

    Article  PubMed  Google Scholar 

  19. Cutuli B, Dilhuydy JM, De Lafontan B, Berlie J, Lacroze M, Lesaunier F, Graic Y, Tortochaux J, Resbeut M, Lesimple T, Gamelin E, Campana F, Reme-Saumon M, Moncho-Bernier V, Cuilliere JC, Marchal C, De Gislain G, N’Guyen TD, Teissier E, Velten M (1997) Ductal carcinoma in situ of the male breast analysis of 31 cases. Eur J Cancer 33:35–38

    Article  CAS  PubMed  Google Scholar 

  20. Schneider S, Sariego J (2009) Male breast cancer presenting as an axillary mass: a case report and literature review. South Med J 102:736–737

    PubMed  Google Scholar 

  21. Namba N, Hiraki A, Tabata M, Kiura K, Ueoka H, Yoshino T, Tanimoto M (2002) Axillary metastasis as the first manifestation of occult breast cancer in a man: a case report. Anticancer Res 22:3611–3613

    PubMed  Google Scholar 

  22. Hines SL, Tan W, Larson JM, Thompson KM, Jorn HKSJ, Files JA (2008) A practical approach to guide clinicians in the evaluation of male patients with breast masses. Geriatrics 63:19–24

    PubMed  Google Scholar 

  23. Günhan-Bilgen I, Bozkaya H, Üstün EE, Memis A (2002) Male breast disease: clinical, mammographic and ultrasonographic features. Eur J Radiol 43:246–255

    Article  PubMed  Google Scholar 

  24. O’Hanlon DM, Kent P, Kerin MJ, Given HF (1995) Unilateral breast masses in men over 40: a diagnostic dilemma. Am J Surg 170:24–26

    Article  PubMed  Google Scholar 

  25. Stierer M, Rosen H, Weitensfelder W, Hausmaninger H, Teleky B, Jakesz R, Fruhwirth H, Dünser M, Beller S, Haid A, Tüchler H (1995) Male breast cancer: Austrian experience. World J Surg 19:687–693

    Article  CAS  PubMed  Google Scholar 

  26. Goss PE, Reid C, Pintilie M, Lim R, Miller N (1999) Male breast carcinoma. A review of 229 patients who presented to the Princess Margaret Hospital during 40 years: 1955–1996. Cancer 85:629–639

    Article  CAS  PubMed  Google Scholar 

  27. Michels LG, Gold RH, Arndt RD (1977) Radiography of gynecomastia and other disorders of the male breast. Radiology 122:117–122

    CAS  PubMed  Google Scholar 

  28. Varas X, Leborgne JH, Leborgne F, Mezzera J, Jaumandreu S, Leborgne F (2002) Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol 179:691–695

    PubMed  Google Scholar 

  29. Atallah NG (2006) Ultrasound guided vacuum breast biopsy for microcalcifications in a male. First case report. J Med Liban 54:161–163

    PubMed  Google Scholar 

  30. Dershaw DD, Borgen PI, Deutch BM, Liberman L (1993) Mammographic findings in men with breast cancer. AJR Am J Roentgenol 160:267–270

    CAS  PubMed  Google Scholar 

  31. Jackson VP, Gilmor RL (1983) Male breast carcinoma and gynecomastia: comparison of mammography with sonography. Radiology 149:533–536

    CAS  PubMed  Google Scholar 

  32. Kim EK, Ko KH, Oh KK, Kwak JY, You JK, Kim MJ, Park BW (2008) Clinical application of the BI-RADS final assessment to breast sonography in conjunction with mammography. AJR Am J Roentgenol 190:1209–1215

    Article  PubMed  Google Scholar 

  33. Yang WT, Whitman GJ, Yuen EHY, Tse GMK, Stelling CB (2001) Sonographic features of primary breast cancer in men. AJR Am J Roentgenol 176:413–416

    CAS  PubMed  Google Scholar 

  34. Janes SE, Lengyel JA, Singh S, Aluwihare N, Isgar B (2006) Needle core biopsy for the assessment of unilateral breast masses in men. Breast 15:273–275

    Article  PubMed  Google Scholar 

  35. Westenend PJ (2003) Core needle biopsy in male breast lesions. J Clin Pathol 56:863–865

    Article  CAS  PubMed  Google Scholar 

  36. Munn S (2002) When should men undergo mammography? AJR Am J Roentgenol 178:1419–1420

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiology Department, Hospital Universitario ‘Reina Sofía’, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain

    Rafaela Muñoz Carrasco, Marina Álvarez Benito & José Luis Raya Povedano

  2. Support Unit for Research, Hospital Universitario ‘Reina Sofía’, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain

    Elisa Muñoz Gomariz

  3. Radiology and Physical Medicine Area, University of Córdoba, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain

    María Martínez Paredes

Authors
  1. Rafaela Muñoz Carrasco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marina Álvarez Benito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisa Muñoz Gomariz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. José Luis Raya Povedano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. María Martínez Paredes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rafaela Muñoz Carrasco.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Muñoz Carrasco, R., Álvarez Benito, M., Muñoz Gomariz, E. et al. Mammography and ultrasound in the evaluation of male breast disease. Eur Radiol 20, 2797–2805 (2010). https://doi.org/10.1007/s00330-010-1867-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-010-1867-7

Keywords

Search

Navigation