A bilateral mammogram is routinely performed in symptomatic males [27], although there is no literature comparing the efficacy of bilateral versus unilateral imaging. A bilateral examination may be useful to assess for symmetry [28] and may detect asymptomatic contralateral gynecomastia or the rare nonpalpable contralateral carcinoma [3]. Although not routinely performed, pectoralis-displaced mammographic views can be acquired if the breast tissue is obscured by overlying well-developed pectoralis musculature [29]. 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 negative predictive values (NPV) 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 an equivocal 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 the male breast are limited. However, DBT can be performed in men and demonstrates similar imaging appearances for benign and malignant male breast disorders as that of mammography [14,15,26]. US Breast If the mammogram is indeterminate or suspicious, US can assist in clinical management and guide biopsy [3]. Variant 4: Male 25 years of age or older with indeterminate palpable breast mass. Mammography or digital breast tomosynthesis indeterminate or suspicious.
Evaluation of the Symptomatic Male Breast. A bilateral mammogram is routinely performed in symptomatic males [27], although there is no literature comparing the efficacy of bilateral versus unilateral imaging. A bilateral examination may be useful to assess for symmetry [28] and may detect asymptomatic contralateral gynecomastia or the rare nonpalpable contralateral carcinoma [3]. Although not routinely performed, pectoralis-displaced mammographic views can be acquired if the breast tissue is obscured by overlying well-developed pectoralis musculature [29]. 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 negative predictive values (NPV) 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 an equivocal 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 the male breast are limited. However, DBT can be performed in men and demonstrates similar imaging appearances for benign and malignant male breast disorders as that of mammography [14,15,26]. US Breast If the mammogram is indeterminate or suspicious, US can assist in clinical management and guide biopsy [3]. Variant 4: Male 25 years of age or older with indeterminate palpable breast mass. Mammography or digital breast tomosynthesis indeterminate or suspicious.