Breast cancer in men typically presents with an irregular mass but may present as a focal asymmetry, asymmetry, or in association with calcifications [3,11,12,24]. Because lobular development does not typically occur in men and men do not have the same background of benign proliferative changes as do women, relatively benign imaging findings, such as a circumscribed mass or round calcifications, should be considered suspicious in male patients [3,6,27]. Mammography is highly sensitive and specific in distinguishing benign from malignant disease and is likely more sensitive than US at detecting breast cancer because microcalcifications may be optimally visualized on this modality [3,6]. Studies demonstrate sensitivities ranging from 92% to 100%, specificities ranging from 90% to 96%, and NPVs of 99% to 100% [3,9,12,28]. Thus, mammography is useful both in identifying breast cancer and for obviating the need for US or biopsy in patients for whom the benign mammographic appearance confirms the clinical impression. DBT 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]. Data on the incremental utility of DBT compared to mammography alone in the evaluation of male breast cancer are limited. However, DBT can be performed in men and demonstrates similar imaging appearances for benign and malignant male breast disorders as mammography [14,15,26]. No documented case of male breast cancer identified solely on DBT has been reported [15]. US Breast Mammography is recommended as the initial imaging study because of its high sensitivity, specificity, and NPV, and the performance of breast US in men may be more variable than mammography [3,9,12,16].
Evaluation of the Symptomatic Male Breast. Breast cancer in men typically presents with an irregular mass but may present as a focal asymmetry, asymmetry, or in association with calcifications [3,11,12,24]. Because lobular development does not typically occur in men and men do not have the same background of benign proliferative changes as do women, relatively benign imaging findings, such as a circumscribed mass or round calcifications, should be considered suspicious in male patients [3,6,27]. Mammography is highly sensitive and specific in distinguishing benign from malignant disease and is likely more sensitive than US at detecting breast cancer because microcalcifications may be optimally visualized on this modality [3,6]. Studies demonstrate sensitivities ranging from 92% to 100%, specificities ranging from 90% to 96%, and NPVs of 99% to 100% [3,9,12,28]. Thus, mammography is useful both in identifying breast cancer and for obviating the need for US or biopsy in patients for whom the benign mammographic appearance confirms the clinical impression. DBT 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]. Data on the incremental utility of DBT compared to mammography alone in the evaluation of male breast cancer are limited. However, DBT can be performed in men and demonstrates similar imaging appearances for benign and malignant male breast disorders as mammography [14,15,26]. No documented case of male breast cancer identified solely on DBT has been reported [15]. US Breast Mammography is recommended as the initial imaging study because of its high sensitivity, specificity, and NPV, and the performance of breast US in men may be more variable than mammography [3,9,12,16].