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Breast Imaging

E2219. Added Value of Imaging for the Symptomatic Male Breast: Can We Avoid Unnecessary Biopsies?

Foo E,  Lee A,  Ray K,  Freimanis R,  Joe B. University of California, San Francisco, San Francisco, CA

Address correspondence to E. Foo (eric.foo@ucsf.edu)

Objective: Although male breast symptoms are most commonly due to gynecomastia, imaging can be used to rule out breast cancer and avert unnecessary biopsies in the setting of a palpable lump or other breast symptoms. Our aim is to review the use and outcomes of diagnostic breast imaging for symptomatic male patients at our academic center.

Materials and Methods: An institutional review board–approved, HIPAA–compliant retrospective chart review was performed to identify male patients who underwent breast imaging at our institution over the course of 10 years (2004–2014). We excluded patients who were transgender, undergoing high-risk screening mammograms, had nonbreast (e.g. axillary) symptoms, or patients with insufficient clinical follow-up to prove benignity. This yielded a final study cohort of 122 patients. Malignant outcomes were determined through biopsy results. Benign outcomes were confirmed either through biopsy or at least 1 year of clinical follow-up. The number of clinical breast biopsies that could have been averted based on negative imaging results were quantified. Descriptive statistics and 2 x 2 table analyses were performed by a statistician.

Results: Mean age was 57 years old (range, 17–92 years). Of 122 patients, 46 (38%) presented with more than one symptom. The most common symptoms for referral to breast imaging were a palpable mass (83/122; 68%), pain or tenderness (57/122; 47%), and diffuse swelling (24/122; 20%). Two cancers (1.6%) were assessed as suspicious on imaging (BI-RADS category 4). The majority (115/122; 94%) of cases had negative imaging results, assessed as either benign (BI-RADS category 2) or negative (BI-RADS category 1), with no cancers found in these cases on clinical follow-up of at least 1 year. Ninety-five patients (78%) were diagnosed with gynecomastia. Fifteen patients underwent percutaneous biopsy. Over half (8/15; 53%) of these biopsies were palpation-guided fine needle aspirations initiated by the referring clinician, despite negative or benign (BI-RADS category 1 or 2) breast imaging results, none of which returned malignant pathology. Imaging demonstrated 100% sensitivity and 96% specificity for identifying breast cancer.

Conclusion: Although malignancy is rarely a cause of male breast symptoms, imaging can be useful to establish a diagnosis of benign disease and to avert unnecessary biopsies. Diagnostic breast imaging demonstrated both high specificity and sensitivity in our study. Over half (53%) of all biopsies in this study could have been avoided based on negative or benign imaging results. In the symptomatic male patient, diagnostic breast imaging can be of clinical value to reduce the number of benign palpation-guided biopsies and to diagnose malignant and benign male breast disease.