ACR Appropriateness Criteria® Evaluation of the Symptomatic Male Breast

Abstract

Although the majority of male breast problems are benign with gynecomastia as the most common etiology, men with breast symptoms and their referring providers are typically concerned about whether or not it is due to breast cancer. If the differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings, or if the clinical presentation is suspicious, imaging is indicated. The panel recommends the following approach to breast imaging in symptomatic men. In men with clinical findings consistent with gynecomastia or pseudogynecomastia, no imaging is routinely recommended. If an indeterminate breast mass is identified, the initial recommended imaging study is ultrasound in men younger than age 25, and mammography or digital breast tomosynthesis in men age 25 and older. If physical examination is suspicious for a male breast cancer, mammography or digital breast tomosynthesis is recommended irrespective of patient age.

Image-based screening for men at high risk for breast cancer: Benefits and drawbacks

“…The detection of malignancy in females is hampered by denser and more diffuse fibroglandular tissue [56,57]. In males, however, the diagnostic performance in the setting of clinical symptoms demonstrates mammography to be highly sensitive and specific, with a high negative predictive value [17,18,20,22,23].…”

“…Gynecomastia, a benign proliferation of breast tissue in men, is the most common differential diagnostic consideration, and is present in approximately half of male breast cancer cases [17]. Distinguishing gynecomastia from male breast cancer, however, is not usually a diagnostic challenge as male breast cancers usually present as an irregular mass with indistinct or spiculated margins sometimes with associated microcalcifications [18][19][20], while gynecomastia most often presents as a retroareolar flame-shaped focal asymmetry [16] ( Figure 2a-b).…”

“…For men 25 years of age or older presenting with a palpable abnormality, bilateral diagnostic mammography [18,21] is the recommended initial imaging test. For men younger than 25 years, diagnostic ultrasound is recommended.…”

“…For men younger than 25 years, diagnostic ultrasound is recommended. Diagnostic mammography is highly sensitive (92-100%), and specific (90-96%) for male breast cancer, with a negative predictive value approaching 100% [17,18,20,22,23]. Diagnostic ultrasound can also be performed as an adjunct tool in the setting of indeterminate mammographic findings and for biopsy planning [18].…”

Hormonioterapia Em Câncer De Mama Masculino Localmente Avançado: Relato De Caso / Hormone Therapy in Locally Advanced Male Breast Cancer: Case Report

“…O quadro clínico do CMH apresenta-se em geral pela nodulação indolor, em geral em região retroareolar, podendo estar associado à: retração do mamilo, ulceração, eliminação de secreção mamilar e adenopatia axilar palpável (RIBEIRO, 1996;VAN GEEL, 1985). A partir da identificação deste exame físico, a mamografia (MMG), tal como no sexo feminino deve ser solicitada, podendo ser complementada pela ultrassonografia (USG) mamária para auxiliar na diferenciação diagnóstica (HANAVADI, 2006;HINES, 2007;NIELL, 2018). A MMG possui uma elevada sensibilidade e especificidade, enquanto a USG pode caracterizar melhor o achado e orientar posteriormente a biópsia (CARRASCO, 2010;NIELL, 2018).…”