Ultrasonographic assessment of male breast diseases

Male Breast: A Review of the Literature and Current State of the Art of Diagnostic Imaging Work-Up

Pathological conditions affecting the male breast (MB) share some similarities with those found in women, while others are specific to men. The first part of this review provides an overview of MB disorders, exploring the most common types of MB diseases. The second part then emphasizes the state-of-the-art approaches proposed in the literature for screening and follow-up with MB cancer patients, which highlights the importance of tailored strategies for diagnosis, follow-up, and identifying high-risk populations. Considering the increasing attention in recent years on the topic, transgender individuals are also included in this review. Together with the MB, it is an understudied category thus far. This review aims to raise awareness among radiologists that MBs should be approached differently from female breasts, contributing to the advancement of medical knowledge, improving patient outcomes, and promoting early detection of MB disorders. The review also provides an update on breast cancer and screening in the transgender population.

Sonographic Features of Palpable Breast and Axillary Lesions in Adult Male Patients: A Pictorial Essay

The male breast is a non-functional and rudimentary organ, but similarly to the female breast, it can be affected by various diseases. In contrast to female breast cancer, male breast cancer has a low incidence, and there is no established breast cancer screening program for male patients. Therefore, the diagnostic evaluation is usually performed in male patients with symptoms such as palpability or pain in the breasts. Furthermore, most adult male patients who visit breast clinics sometimes present with not only breast symptoms but also axillary symptoms, and both the breast and axilla are usually examined during breast ultrasonography in daily clinical practice. The purpose of this pictorial essay was to present the sonographic features of various palpable breast and axillary lesions in adult male patients.

Benign cyst of the male breast. An exceedingly rare entity that may pose a diagnostic dilemma. Management and literature review

Cysts represent the most common cause of a breast mass in women. On the contrary, in men, the presence of a benign apocrine cyst is an exceedingly rare occurrence, with only a few cases reported in the literature. We describe herein a case of benign apocrine breast cyst without concurrent gynecomastia in a 41-year-old male. Diagnostic evaluation and management are discussed, along with a review of the literature. Given the extreme rarity of benign breast cysts in males, a thorough investigation is essential in male patients presenting with cystic breast lesions. Diagnostic breast imaging may be challenging. Surgical resection of the cyst should be considered in the presence of atypical imaging features to exclude underlying malignancy.

Genetic Landscape of Male Breast Cancer

Male breast cancer (MBC) is now considered molecularly different from female breast cancer (FBC). Evidence from studies indicates that common genetic and epigenetic features of FBC are not shared with those diagnosed in men. Genetic predisposition is likely to play a significant role in the tumorigenesis of this rare disease. Inherited germline variants in BRCA1 and BRCA2 account for around 2% and 10% of MBC cases, respectively, and the lifetime risk of breast cancer for men harboring BRCA1 and BRCA2 mutations is 1.2% and 6.8%. As for FBC, pathogenic mutations in other breast cancer genes have also been recently associated with an increased risk of MBC, such as PALB2 and CHEK2 mutations. However, while multigene germline panels have been extensively performed for BC female patients, the rarity of MBC has resulted in limited data to allow the understanding of the magnitude of risk and the contribution of recently identified moderate penetrance genes of FBC for MBC predisposition. This review gathers available data about the germline genetic landscape of men affected by breast cancer, estimated risk associated with these genetic variants, and current guidelines for clinical management.

Differential diagnosis of benign and malignant male breast lesions in mammography

PURPOSE

To investigate the mammographic characteristics in discriminating benign and malignant male breast lesions.

METHODS

Male patients with breast lesions detected by preoperative mammography were enrolled in this study from Jan 2011 to Dec 2018. All lesions were confirmed by biopsy and classified into benign group or malignant group. Imaging features included lesions location, lesion type, lesion density, lesion eccentricity, accompanying signs(calcification, nipple retraction, thickened skin and enlarged lymph nodes) were recorded and analysed by statistical methods. The AUC was calculated to assess their diagnostic performance in distinguishing benign and malignant lesions. This model was further validated by 0.632 bootstrap.

RESULTS

A total of 93 men(median age: 60, range 32-81 years) were enrolled, 43 patients in the benign group and 50 patients in the malignant group. In the univariate logistic analysis, age, lesion location, lesion type, lesion density, lesion eccentricity, calcification, nipple retraction and skin thickening were significantly different (p < 0.05). When the lesion showed a mass in mammography, those with a circumscribed margin were likely malignant (p < 0.05). In the multivariate logistic analysis, non-retro-areola lesions (OR: 6.900, 95 % CI: 1.413∼33.691, p < 0.05), eccentric lesions (OR: 14.566, 95 % CI: 2.800∼75.777, p < 0.05), high-density lesions (OR: 11.052, 95 % CI: 2.235∼54.666, p < 0.05), calcification (OR: 12.715 95 % CI: 1.316∼122.848, p < 0.05) and nipple retraction (OR: 24.681, 95 % CI: 2.853∼213.542 p < 0.05) were associated with breast cancer. Those variables were used to build logistic model and the AUC of the imaging model was 0.904. The imaging model was verified by 0.632 bootstrap resampling, and the AUC after 0.632 bootstrap was 0.892.

CONCLUSION

Mammographic characteristics could contribute to distinguishing malignant and benign male breast lesions, and the imaging model showed excellent diagnostic performance, which may help to guide clinical decision-making.

Breast Cancer Screening in High-Risk Men: A 12-year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes

Background Male breast cancer incidence is rising. There may be a potential role in selective screening in men at elevated risk for breast cancer, but the effectiveness of such screening remains unexplored. Purpose To evaluate patterns of male breast imaging utilization, to determine high-risk screening outcomes, and to delineate risk factors associated with cancer diagnosis. Materials and Methods This retrospective study reviewed consecutive male breast imaging examinations over a 12-year period (between 2005-2017). Examination indications, biopsy recommendations, and pathologic results were correlated with patient characteristics. Fisher exact test, Mann-Whitney test, Spearman correlation, and logistic regression were used for statistical analysis. Results A total of 1869 men (median age, 55 years; range, 18-96 years) underwent 2052 examinations yielding 2304 breast lesions and resulting in 149 (6.5%) biopsies in 133 men; 41 (27.5%) were malignant and 108 (72.5%) were benign. There were 1781 (86.8%) diagnostic and 271 (13.2%) screening examinations. All men undergoing screening had personal or family history of breast cancer and/or genetic mutations. There was a significant increase in the number of examinations in men relative to the number of examinations in women over time (Spearman correlation, r = 0.85; P < .001). Five node-negative cancers resulted from screening mammography, yielding a cancer detection rate of 18 per 1000 examinations (95% confidence interval [CI]: 7, 41), with cancers diagnosed on average after 4 person-years of screening (range, 1-10 person-years). Mammographic screening sensitivity, specificity, and positive predictive value of biopsy were 100% (95% CI: 50%, 100%), 95.0% (95% CI: 93.1%, 98%), and 50% (95% CI: 22.2%, 77.8%). Older age (P < .001), Ashkenazi descent (P < .001), genetic mutations (P = .006), personal history (P < .001), and first-degree family history (P = .03) were associated with breast cancer. Non-first-degree family history was not associated with cancer (P = .09). Conclusion There is potential benefit in screening men at high risk for developing breast cancer. Such screening may have increased over time. © RSNA, 2019.

Pseudoangiomatous Stromal Hyperplasia of the Breast: A Rare Finding in a Male Patient

Pseudoangiomatous stromal hyperplasia (PASH) in male patients is a rare condition that represents a hormonally-induced proliferation of mesenchymal tissue of the breast. This benign pathology is often undiagnosed due to many reasons. When PASH presents as a breast mass, it appears innocent, developing as a smooth and well-circumscribed tumor. Furthermore, it does not elicit suspicious findings on imaging. These points often halt further investigation of many breast abnormalities. Breast masses are statistically most likely to be gynecomastia when they arise in men. However, they are important to investigate because, although rare, breast cancer can occur in men. Furthermore, the benign conditions of the breast that commonly affect women can also impact male patients. It is oftentimes overlooked that men too can experience hormonal stimulation of the breast tissue. The following case describes this rare but important instance of a male patient diagnosed with PASH following a previous diagnosis of infiltrative ductal carcinoma in situ of the contralateral breast.