US Breast If the mammogram is indeterminate or suspicious, US is usually appropriate as the next imaging modality because US can assist in lesion characterization and guide biopsy [3]. Performance of breast US in men may be more variable than mammography. Carrasco et al [3], in their series of 638 patients, reported a lower sensitivity of US for distinguishing benign from malignant disease (88.9% compared to 95% for mammography) but a similar, high specificity of 95%. However, Patterson et al [28], in a series of 166 patients, reported US to have the same sensitivity as mammography (100%) but lower specificity (74%). MRI Breast Breast MRI is generally not indicated for the evaluation of indeterminate palpable breast masses in men. Variant 5: Male of any age with physical examination suspicious for breast cancer (suspicious palpable breast mass, axillary adenopathy, nipple discharge, or nipple retraction). Initial imaging. Breast cancer is a disease of older men and typically presents at a later age (median age of 63 years) than in women [5]. Male breast cancer is rarely bilateral and typically presents with a painless, hard mass, which may be subareolar or, unlike gynecomastia, eccentric to the nipple. With breast cancer, there may be secondary signs of malignancy, such as nipple or skin retraction, nipple discharge, or axillary lymphadenopathy [6]. Breast cancers in Evaluation of the Symptomatic Male Breast men often present at a more advanced stage than breast cancers in women, with up to 47% of men having axillary nodal involvement at the time of diagnosis [6]. In addition, nipple discharge is suspicious for breast cancer in men, with 2 studies showing carcinoma in 23% to 57% of men presenting with this symptom [7,8]. Mammography For men with a suspicious physical examination finding, mammography or DBT is recommended as the initial imaging study because mammography has high sensitivity, specificity, and NPV [3,9,12,16].
Evaluation of the Symptomatic Male Breast. US Breast If the mammogram is indeterminate or suspicious, US is usually appropriate as the next imaging modality because US can assist in lesion characterization and guide biopsy [3]. Performance of breast US in men may be more variable than mammography. Carrasco et al [3], in their series of 638 patients, reported a lower sensitivity of US for distinguishing benign from malignant disease (88.9% compared to 95% for mammography) but a similar, high specificity of 95%. However, Patterson et al [28], in a series of 166 patients, reported US to have the same sensitivity as mammography (100%) but lower specificity (74%). MRI Breast Breast MRI is generally not indicated for the evaluation of indeterminate palpable breast masses in men. Variant 5: Male of any age with physical examination suspicious for breast cancer (suspicious palpable breast mass, axillary adenopathy, nipple discharge, or nipple retraction). Initial imaging. Breast cancer is a disease of older men and typically presents at a later age (median age of 63 years) than in women [5]. Male breast cancer is rarely bilateral and typically presents with a painless, hard mass, which may be subareolar or, unlike gynecomastia, eccentric to the nipple. With breast cancer, there may be secondary signs of malignancy, such as nipple or skin retraction, nipple discharge, or axillary lymphadenopathy [6]. Breast cancers in Evaluation of the Symptomatic Male Breast men often present at a more advanced stage than breast cancers in women, with up to 47% of men having axillary nodal involvement at the time of diagnosis [6]. In addition, nipple discharge is suspicious for breast cancer in men, with 2 studies showing carcinoma in 23% to 57% of men presenting with this symptom [7,8]. Mammography For men with a suspicious physical examination finding, mammography or DBT is recommended as the initial imaging study because mammography has high sensitivity, specificity, and NPV [3,9,12,16].