Chen et al [19] evaluated the incremental clinical value of US in 327 symptomatic male patients where mammography was negative or revealed only gynecomastia and found no additional malignancies. However, in that series, US did lead to additional unnecessary benign biopsies. Tangerud et al [20], in a study of 350 men with mammographic findings diagnostic of gynecomastia, did not identify any patients with male breast cancer when US, fine needle aspiration, or core biopsy was performed in conjunction with mammography. When performed for suspected gynecomastia, US may demonstrate a lack of breast tissue in men with pseudogynecomastia and obviate further unnecessary interventions for falsely presumed gynecomastia (eg, altering medications) [12,21-23]. MRI Breast In men with clinical findings consistent with gynecomastia or pseudogynecomastia, breast MRI is not indicated as the initial imaging study. There is no relevant literature regarding the use of breast MRI as the initial imaging evaluation of suspected gynecomastia. Variant 2: Male younger than 25 years of age with indeterminate palpable breast mass. Initial imaging. Only 6% of male breast cancers occur in men <40 years of age and 1% in men <30 years of age [24]. Given the relationship between breast cancer incidence and increasing age, age-based protocols in younger men have been developed [3,25]. If clinical breast examination is indeterminate, imaging is recommended prior to biopsy recommendation. Mammography The extremely low incidence of breast cancer in young men reduces the utility of mammography as the initial imaging study. However, if there are suspicious or indeterminate features on US, mammography or DBT should be performed before a biopsy recommendation is made because diagnostic mammography is useful in distinguishing malignancy from benign breast conditions in symptomatic males [1,2].
Evaluation of the Symptomatic Male Breast. Chen et al [19] evaluated the incremental clinical value of US in 327 symptomatic male patients where mammography was negative or revealed only gynecomastia and found no additional malignancies. However, in that series, US did lead to additional unnecessary benign biopsies. Tangerud et al [20], in a study of 350 men with mammographic findings diagnostic of gynecomastia, did not identify any patients with male breast cancer when US, fine needle aspiration, or core biopsy was performed in conjunction with mammography. When performed for suspected gynecomastia, US may demonstrate a lack of breast tissue in men with pseudogynecomastia and obviate further unnecessary interventions for falsely presumed gynecomastia (eg, altering medications) [12,21-23]. MRI Breast In men with clinical findings consistent with gynecomastia or pseudogynecomastia, breast MRI is not indicated as the initial imaging study. There is no relevant literature regarding the use of breast MRI as the initial imaging evaluation of suspected gynecomastia. Variant 2: Male younger than 25 years of age with indeterminate palpable breast mass. Initial imaging. Only 6% of male breast cancers occur in men <40 years of age and 1% in men <30 years of age [24]. Given the relationship between breast cancer incidence and increasing age, age-based protocols in younger men have been developed [3,25]. If clinical breast examination is indeterminate, imaging is recommended prior to biopsy recommendation. Mammography The extremely low incidence of breast cancer in young men reduces the utility of mammography as the initial imaging study. However, if there are suspicious or indeterminate features on US, mammography or DBT should be performed before a biopsy recommendation is made because diagnostic mammography is useful in distinguishing malignancy from benign breast conditions in symptomatic males [1,2].