Male Breast Cancer Imaging
- Author: Lars J Grimm, MD, MHS; Chief Editor: Eugene C Lin, MD more...
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, 18]
Risk factors for male breast cancer include BRCA mutation, estrogen exposure/androgen insufficiency (Klinefelter syndrome, obesity, cirrhosis, exogenous estrogen therapy, testicular abnormality), and radiation exposure.[19, 20]
Male breast cancer is most commonly invasive ductal or ductal carcinoma in situ (DCIS). Male breasts lack terminal ductal lobular units, thus lobular carcinoma is extremely rare except in cases of estrogen exposure.
The majority of male breast cancers are estrogen and progesterone receptor positive, like in female breast cancer. However, male breast cancer is 3 times less likely to be HER2 positive.
There are 1,900 men diagnosed with breast cancer yearly, compared with 190,000 women, but the case fatality rate is similar.
The incidence of male breast cancer peaks at age 71 years.
Other problems to be considered
Problems to be considered include the following:
An ultrasound-guided core-needle biopsy can be safely performed if there is sufficient clinical and radiologic evidence to suggest breast cancer.
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 or worrisome for malignancy, then additional evaluation with mammography and/or ultrasound may be appropriate.[18, 23, 24, 25, 26, 27, 28, 29, 30, 31]
For patients at high risk of breast cancer (family history, genetic predisposition, personal history of breast cancer), recommendations include monthly breast self-examinations, semiannual clinical breast examinations, and baseline followed by yearly mammography if gynecomastia or breast density are seen.
On mammography, male breast cancer is typically retroareolar as it arises from the central ducts. An eccentric position is not typical for gynecomastia. Masses are most commonly high density with an irregular shape. Margins are usually spiculated, lobulated, or microlobulated.
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, 24, 25] Nipple retraction, skin thickening, and increased trabeculation are worrisome findings.
Mammography is highly sensitive and specific for breast cancer in men, but it should be used to complement the clinical examination. Cases of carcinoma have been found by ultrasonography after they were obscured on previous mammograms by gynecomastia.
Bilateral mammography should always be obtained to help in the evaluation of the baseline breast architecture and to identify contralateral disease.
See the image below.
Magnetic Resonance Imaging
MRI is generally not indicated in the workup for male breast cancer unless there is concern for chest wall invasion. Features worrisome for female breast cancer are the same for male breast cancer: spiculated margins, washout enhancement kinetics, and abnormal lymphadenopathy.
Ultrasound features of male breast cancer are similar to those of female breast cancer. Masses that are taller than wide (antiparallel) and hypoechoic are worrisome. The margins are angulated, microlobulated, or spiculated.[27, 23]
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.
Evaluation of axillary lymph nodes is important if there is high clinical suspicion for breast cancer. Abnormal lymph nodes with an absent fatty hilum and asymmetric cortical thickness are suspicious for regional metastatic disease.
Appelbaum AH, Evans GF, Levy KR, et al. Mammographic appearances of male breast disease. Radiographics. 1999 May-Jun. 19(3):559-68. [Medline].
Carmalt HL, Mann LJ, Kennedy CW, et al. Carcinoma of the male breast: a review and recommendations for management. Aust N Z J Surg. 1998 Oct. 68(10):712-5. [Medline].
Donegan WL, Redlich PN. Breast cancer in men. Surg Clin North Am. 1996 Apr. 76(2):343-63. [Medline].
Newman J. Breast cancer in men and mammography of the male breast. Radiol Technol. 1997 Sep-Oct. 69(1):17-28; quiz 29-36. [Medline].
Ravandi-Kashani F, Hayes TG. Male breast cancer: a review of the literature. Eur J Cancer. 1998 Aug. 34(9):1341-7. [Medline].
Stewart RA, Howlett DC, Hearn FJ. Pictorial review: the imaging features of male breast disease. Clin Radiol. 1997 Oct. 52(10):739-44. [Medline].
Winchester DJ. Male breast cancer. Semin Surg Oncol. 1996 Sep-Oct. 12(5):364-9. [Medline].
Contractor KB, Kaur K, Rodrigues GS, Kulkarni DM, Singhal H. Male breast cancer: is the scenario changing. World J Surg Oncol. 2008 Jun 16. 6:58. [Medline].
Lanitis S, Rice AJ, Vaughan A, Cathcart P, Filippakis G, Mufti RA, et al. Diagnosis and Management of Male Breast Cancer. World J Surg. 2008 Sep 12. [Medline].
Schaub NP, Maloney N, Schneider H, Feliberti E, Perry R. Changes in male breast cancer over a 30-year period. Am Surg. 2008 Aug. 74(8):707-11; discussion 711-2. [Medline].
Grenader T, Goldberg A, Shavit L. Second cancers in patients with male breast cancer: a literature review. J Cancer Surviv. 2008 Jun. 2(2):73-8. [Medline].
La Pinta M, Fabi A, Ascarelli A, Ponzani T, Di Carlo V, Scicchitano F, et al. Male breast cancer: 6-year experience. Minerva Chir. 2008 Apr. 63(2):71-8. [Medline].
Pant K, Dutta U. Understanding and management of male breast cancer: a critical review. Med Oncol. 2007 Dec 12. [Medline].
Leinung S, Horn LC, Backe J. [Male breast cancer: history, epidemiology, genetic and histopathology]. Zentralbl Chir. 2007 Oct. 132(5):379-85. [Medline].
Dimitrov NV, Colucci P, Nagpal S. Some aspects of the endocrine profile and management of hormone-dependent male breast cancer. Oncologist. 2007 Jul. 12(7):798-807. [Medline].
Cutuli B. Strategies in treating male breast cancer. Expert Opin Pharmacother. 2007 Feb. 8(2):193-202. [Medline].
Agrawal A, Ayantunde AA, Rampaul R, Robertson JF. Male breast cancer: a review of clinical management. Breast Cancer Res Treat. 2007 May. 103(1):11-21. [Medline].
Taylor K, Ames V, Wallis M. The diagnostic value of clinical examination and imaging used as part of an age-related protocol when diagnosing male breast disease: An audit of 1141 cases from a single centre. Breast. 2013 Apr 6. [Medline].
Johansen Taber KA, Morisy LR, Osbahr AJ 3rd, Dickinson BD. Male breast cancer: risk factors, diagnosis, and management (Review). Oncol Rep. 2010 Nov. 24(5):1115-20. [Medline].
Mohamad HB, Apffelstaedt JP. Counseling for male BRCA mutation carriers: a review. Breast. 2008 Oct. 17(5):441-50. [Medline].
Ottini L, Palli D, Rizzo S, Federico M, Bazan V, Russo A. Male breast cancer. Crit Rev Oncol Hematol. 2010 Feb. 73(2):141-55. [Medline].
Fentiman IS, Fourquet A, Hortobagyi GN. Male breast cancer. Lancet. 2006 Feb 18. 367(9510):595-604. [Medline].
Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, et al. Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006 Jul-Aug. 26(4):993-1006. [Medline].
Günhan-Bilgen I, Bozkaya H, Ustün EE, Memis A. Male breast disease: clinical, mammographic, and ultrasonographic features. Eur J Radiol. 2002 Sep. 43(3):246-55. [Medline].
Lattin GE Jr, Jesinger RA, Mattu R, Glassman LM. From the radiologic pathology archives: diseases of the male breast: radiologic-pathologic correlation. Radiographics. 2013 Mar-Apr. 33(2):461-89. [Medline].
Patterson SK, Helvie MA, Aziz K, Nees AV. Outcome of men presenting with clinical breast problems: the role of mammography and ultrasound. Breast J. 2006 Sep-Oct. 12(5):418-23. [Medline].
Yang WT, Whitman GJ, Yuen EH, Tse GM, Stelling CB. Sonographic features of primary breast cancer in men. AJR Am J Roentgenol. 2001 Feb. 176(2):413-6. [Medline].
Evangelista L, Bertagna F, Bertoli M, Stela T, Saladini G, Giubbini R. DIAGNOSTIC AND PROGNOSTIC VALUE OF 18F-FDG PET/CT IN MALE BREAST CANCER: RESULTS FROM A BICENTRIC POPULATION. Curr Radiopharm. 2015 May 28. [Medline].
Groheux D, Hindié E, Marty M, Espié M, Rubello D, Vercellino L, et al. ¹⁸F-FDG-PET/CT in staging, restaging, and treatment response assessment of male breast cancer. Eur J Radiol. 2014 Oct. 83 (10):1925-33. [Medline].
Mainiero MB, Lourenco AP, Barke LD, Argus AD, Bailey L, Carkaci S, et al. ACR Appropriateness Criteria Evaluation of the Symptomatic Male Breast. J Am Coll Radiol. 2015 Jul. 12 (7):678-82. [Medline].
Nguyen C, Kettler MD, Swirsky ME, Miller VI, Scott C, Krause R, et al. Male breast disease: pictorial review with radiologic-pathologic correlation. Radiographics. 2013 May. 33 (3):763-79. [Medline].