Male Breast Cancer Imaging 

  • Author: Marilyn A Roubidoux, MD; Chief Editor: Eugene C Lin, MD   more...
 
Updated: May 27, 2011
 

Overview

Male breast cancer is similar to breast cancer in females in its etiology, family history, prognosis, and treatment. In approximately 30% of cases of breast cancer in men, the family history is positive for the disease. A familial form of breast cancer is seen in which both genders are at increased risk for breast cancer. Male breast neoplasms are relatively rare, in contrast to gynecomastia, which is a relatively common condition.[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]

Preferred Examination

The clinical examination is key in the evaluation of a palpable mass in a male. If the clinical features strongly suggest gynecomastia, further evaluation may not be necessary. If the clinical features are equivocal, fine-needle aspiration guided by palpation and/or excisional biopsy are necessary to make the diagnosis.

Accurate diagnosis with mammography alone has been reported, with a sensitivity and specificity of at least 90%. If clinical examination and mammography both reveal benign findings, a biopsy may be unnecessary. Given the rarity of male breast cancer, mammography screening guidelines are not available for men.[18, 19]

Ultrasonography can demonstrate a cyst in a male, but cysts are rare. A mammogram showing only fat can be helpful in cases of unilateral breast enlargement without a mass, but in general, this finding is not concerning for breast cancer and does not require further evaluation of the breast.

Although some mammographic findings do suggest male breast cancer (eg, an eccentric spiculated mass), mammography or ultrasonography has not been compared with the predictive value of a clinical breast examination and fine-needle aspiration. Considerable overlap also exists in the ultrasonographic appearance of these entities.[6]

Magnetic resonance imaging has not been studied regarding its sensitivity in making a diagnosis, but since the lesions are always palpable and can be biopsied easily under palpation, there is no clear role for MRI.

See the image below of Male Breast Cancer.

A partially circumscribed retroareolar mass in a mA partially circumscribed retroareolar mass in a male with suspicious microcalcifications; this is known breast cancer.

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education articles Breast Cancer, Breast Lumps and Pain, and Breast Self-Exam.

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Radiography

On mammography, male breast cancer is subareolar or somewhat eccentric to the nipple, with well-defined, ill-defined, or spiculated margins. Calcifications are observed less commonly than in female breast cancer and, when found, are coarser in appearance. Calcifications can also be seen in fat necrosis. Axillary adenopathy may be observed as well.[1, 18]

Mammography is highly sensitive and specific for breast cancer in men, but it should be used to complement the clinical examination. At present, not enough clinical data are available to determine whether the combination of imaging and clinical findings can replace biopsy for the diagnosis of palpable breast abnormalities in men. Ultimately, biopsy should be considered to diagnose male breast cancer because the findings of inflammation, gynecomastia, and fat necrosis can be similar; therefore, these conditions can cause false-positive findings. Cases of carcinoma have been found by ultrasonography after they were obscured on previous mammograms by gynecomastia.[20]

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Ultrasonography

A hypoechoic mass with irregular, ill-defined, or circumscribed margins may be observed on ultrasonography. With color flow imaging, vascular flow within the mass may be demonstrated.[18, 20]

Similar sonographic findings may be observed in gynecomastia or inflammation; therefore, ultrasonography alone is not a reliable method to distinguish male breast cancer from other etiologies. Abscesses, gynecomastia, and fat necrosis may all give false positives.

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Contributor Information and Disclosures
Author

Marilyn A Roubidoux, MD  Professor of Radiology, Division of Breast Imaging, University of Michigan Health System

Disclosure: Nothing to disclose.

Coauthor(s)

Stephanie K Patterson, MD  Clinical Associate Professor, Department of Breast Imaging, University of Michigan Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

John M Lewin, MD  Section Chief, Breast Imaging, Diversified Radiology of Colorado, PC; Associate Clinical Professor, Department of Preventative Medicine and Biometrics, University of Colorado School of Medicine

John M Lewin, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, Radiological Society of North America, and Society of Breast Imaging

Disclosure: Philips Healthcare Consulting fee Consulting

Bernard D Coombs, MB, ChB, PhD  Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Edward Azavedo, MD, PhD  Director of Clinical Breast Imaging Services, Associate Professor, Department of Radiology, Karolinska University Hospital, Sweden

Edward Azavedo, MD, PhD is a member of the following medical societies: Swedish Medical Association and Swedish Society of Medicine

Disclosure: Nothing to disclose.

Robert M Krasny, MD  Resolution Imaging Medical Corporation

Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD  Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine

Disclosure: Nothing to disclose.

References

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  19. Evans GF, Anthony T, Turnage RH, et al. The diagnostic accuracy of mammography in the evaluation of male breast disease. Am J Surg. Feb 2001;181(2):96-100. [Medline].

  20. Patterson SK, Helvie MA, Aziz K, Nees AV. Outcome of men presenting with clinical breast problems: the role of mammography and ultrasound. Breast J. Sep-Oct 2006;12(5):418-23. [Medline].

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A partially circumscribed retroareolar mass in a male with suspicious microcalcifications; this is known breast cancer.
 
 
 
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