Fine‐needle aspiration cytology of the male breast in a cancer center

Abstract

All fine-needle aspirates (FNA) performed on the male breast at The University of Texas M. D. Anderson Cancer Center from 1985 to 1992 were reviewed, totaling 64. The patients' ages ranged from 19 to 86 years, with a mean of 56 years. Thirty-three patients had a history of an extramammary malignancy. The diagnoses established by FNA were gynecomastia (45), mammary carcinomas (6), neoplasms metastatic to the breast (5), suspicious for carcinoma (1), intra-mammary lymph node (1), and lipoma (1). In five cases the aspirates were nondiagnostic. Two of these proved to be gynecomastia on subsequent histologic examination. Of the six FNA cases initially thought to represent primary breast carcinomas, two were found to be secondary because of involvement of the underlying chest wall by mesothelioma (1), and mucinous adenocarcinoma, unknown primary (1). No false-positive diagnosis was rendered. We conclude that fine-needle aspiration of the male breast is a reliable means of assessment; however, unique problems may be encountered compared with aspiration of the female breast. These include the epithelial hyperplasia frequently associated with gynecomastia, the relatively equal frequency of primary and metastatic breast lesions when a malignant process is discovered, and chest wall lesions masquerading as breast lesions.

Diagnostic Value of Fine-Needle Aspiration in Male Breast Lesions

“…Core needle biopsy has emerged as a challenger to FNA biopsy in recent decades, especially in high-resource settings. Previous studies have demonstrated high diagnostic accuracy, sensitivity, and specificity of FNA biopsy for breast lesions in both men and women [7, 9, 16, 18, 19, 31, 32]. Our group has shown that FNA biopsy for palpable breast lesions is a rapid, cost-effective, time-efficient method and lacks virtually any contraindication, while maintaining a high specificity and sensitivity and a low nondiagnostic rate [9, 11].…”

Gynecomastia

“…10 Sneige et al reported apocrine metaplasia in 5.6% and foamy histiocytes in 22% of cytologic smears obtained from 45 patients with gynecomastia. 8 In our series of 100 patients with gynecomastia, apocrine metaplasia and foamy histiocytes were noted in 8% and 12% of the cases, respectively.…”

“…In the control group, the cytologic findings in the cases of intraductal carcinoma included numerous crine metaplasia in gynecomastia, 8 while others have specifically stated that apocrine metaplasia and foamy histiocytes are not features of it. 3 Another paper claims that apocrine metaplasia does occur in gynecomastia and that its presence confirms the nonneoplastic nature of the lesion.…”

Efficiency of Imaging Modalities in Male Breast Disease: Can Ultrasound Give Additional Information for Assessment of Gynecomastia Evolution?

“…In the past, surgical intervention and percutaneous biopsy in men with a palpable breast mass had been performed without breast imaging (3). However, it has been reported that percutaneous biopsies can lead to misdiagnosis (13). As stated Munn et al (14) combined use of mammosonography could substantially reduce the need for biopsy.…”