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 95.3%. 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%). In conjunction with mammography or DBT, US is often useful in assisting with management decisions and to facilitate US core biopsy [3]. Male breast cancers typically manifest as hypoechoic solid masses with irregular borders; however, cystic or circumscribed masses in men should also be viewed with suspicion unless definitely correlative benign findings (eg, oil cyst) are identified on mammography [3,11,24,30,31]. Lapid et al [32] in a series of 557 male patients demonstrated that mammography and/or US imaging in combination had an NPV of 99.8%, and a complex cystic and solid mass on US was the only false-negative examination. Summary of Recommendations Variant 1: Imaging is not recommended for the initial imaging of a male patient of any age with symptoms of gynecomastia and physical examination consistent with gynecomastia or pseudogynecomastia. Variant 2: US breast is usually appropriate for the initial imaging of a male patient younger than 25 years of age with an indeterminate palpable breast mass. Variant 3: Diagnostic mammography or DBT is usually appropriate for the initial imaging of a male patient 25 years of age or older with an indeterminate palpable breast mass. These procedures are equivalent alternatives. 6 Variant 4: US breast is usually appropriate for the imaging of a male patient 25 years of age or older with a breast mass deemed indeterminate or suspicious on diagnostic mammography or DBT.
Evaluation of the Symptomatic Male Breast. 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 95.3%. 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%). In conjunction with mammography or DBT, US is often useful in assisting with management decisions and to facilitate US core biopsy [3]. Male breast cancers typically manifest as hypoechoic solid masses with irregular borders; however, cystic or circumscribed masses in men should also be viewed with suspicion unless definitely correlative benign findings (eg, oil cyst) are identified on mammography [3,11,24,30,31]. Lapid et al [32] in a series of 557 male patients demonstrated that mammography and/or US imaging in combination had an NPV of 99.8%, and a complex cystic and solid mass on US was the only false-negative examination. Summary of Recommendations Variant 1: Imaging is not recommended for the initial imaging of a male patient of any age with symptoms of gynecomastia and physical examination consistent with gynecomastia or pseudogynecomastia. Variant 2: US breast is usually appropriate for the initial imaging of a male patient younger than 25 years of age with an indeterminate palpable breast mass. Variant 3: Diagnostic mammography or DBT is usually appropriate for the initial imaging of a male patient 25 years of age or older with an indeterminate palpable breast mass. These procedures are equivalent alternatives. 6 Variant 4: US breast is usually appropriate for the imaging of a male patient 25 years of age or older with a breast mass deemed indeterminate or suspicious on diagnostic mammography or DBT.