Value of mammography and breast ultrasound in male patients with nipple discharge

Carrasco, Rafaela Muñoz; Benito, Marina Álvarez; Campo, Eleonor Rivin del

doi:10.1016/j.ejrad.2012.10.019

Cited by 27 publications

(22 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We only partially agree with the conclusion of Hines et al. Mammography is an objective and reproducible imaging method, feasible by technicians with high diagnostic accuracy . Breast cancer treatment is better ensured by complete information about the extent of the disease.…”

Section: Discussionsupporting

confidence: 66%

Overuse of Imaging the Male Breast-Findings in 557 Patients

Lapid

Siebenga

Zonderland³

2015

Breast J

View full text Add to dashboard Cite

Gynecomastia is the most common abnormality of the male breast. However, breast cancer may occur, albeit with a significantly lower incidence than in females. Imaging is often used as part of the diagnosis. The aim of this study was to assess the utilization and outcome of imaging with mammography or ultrasound of the male breast in a university hospital's department of radiology. A retrospective study assessing the imaging of the male breast in 557 patients over a 10-year period. Referral was done mainly by general surgeons and general practitioners. The most common indication was enlargement of the breast, described as gynecomastia or swelling in 74% of patients, followed by pain in 24% and "lumps" in 10%. The modalities used were mammography in 65%, ultrasound in 51% and both in 26%. Most examinations, 519, were BI-RADS 1 or 2, and 38 were BI-RADS 3 or higher. Altogether 160 patients had additional fine-needle aspiration or biopsy. Malignancies were diagnosed in five patients (0.89%). Imaging had a sensitivity of 80% and a specificity of 99%. The positive predictive value was 44% and the negative predictive value 99.8%. Malignancies are rare in the male breast. The probability of finding cancer when performing imaging of clinically benign findings in the male breast is negligible. Imaging is not warranted unless there are suspicious abnormalities. Routine imaging of gynecomastia should be discouraged.

show abstract

Section: Discussionsupporting

confidence: 66%

Overuse of Imaging the Male Breast-Findings in 557 Patients

Lapid

Siebenga

Zonderland³

2015

Breast J

View full text Add to dashboard Cite

show abstract

“…Mammography or DBT should be performed as the initial study in men >25 years old, given the high incidence of cancer in men with pathologic nipple discharge. See references [9,[14][15][16][17]65,[68][69][70].…”

Section: Mammography Diagnosticmentioning

confidence: 99%

ACR Appropriateness Criteria ® Evaluation of Nipple Discharge

Lee

Trikha

Moy³

et al. 2017

Journal of the American College of Radiology

View full text Add to dashboard Cite

Appropriate imaging evaluation of nipple discharge depends the nature of the discharge. Imaging is not indicated for women with physiologic nipple discharge. For evaluation of pathologic nipple discharge, multiple breast imaging modalities are rated for evidence-based appropriateness under various scenarios. For women age 40 or older, mammography or digital breast tomosynthesis (DBT) should be the initial examination. Ultrasound is usually added as a complementary examination, with some exceptions. For women age 30 to 39, either mammogram or ultrasound may be used as the initial examination on the basis of institutional preference. For women age 30 or younger, ultrasound should be the initial examination, with mammography/DBT added when ultrasound shows suspicious findings or if the patient is predisposed to developing breast cancer. For men age 25 or older, mammography/DBT should be performed initially, with ultrasound added as indicated, given the high incidence of breast cancer in men with pathologic nipple discharge. Although MRI and ductography are not usually appropriate as initial examinations, each may be useful when the initial standard imaging evaluation is negative. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

show abstract

“…In the absence of other clinical signs, the presence of nipple discharge may be an indicator of a non-invasive disease, and early identification of this symptom is therefore important [41] [42]. The primary tumour may be of varying size between 1.8 and 3.5 cm [6] [25] [27] [40] but older patients have larger tumours in more advanced stages at diagnosis, compared with younger patients [43].…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Morrogh & King (2009) [68] have also reported that ultrasound, with 100% sensitivity and 100% specificity, is superior to mammography. But several studies have shown that both techniques with a negative predictive value (NPV) close to 100% make it possible to avoid a large number of unnecessary surgical interventions in men [42] [66] [50]. Since experience with male breast mammography is limited, with a high rate of false positive results due to gynecomastia and cysts [69], biopsy biopsy, in order to allow a definitive diagnosis in most breast cancer cases in men [57] [70].…”

Section: Diagnosismentioning

confidence: 99%

Male Breast Cancer Clinical Features, Risk Factors, and Current Diagnostic and Therapeutic Approaches

Darkeh¹,

Azavedo²

2014

IJCM

View full text Add to dashboard Cite

Objective: To review presentation, diagnosis, treatment and prognosis of male breast cancer. Method: A systematic review of the English language literature between 1990 and 2013 was conducted to identify studies relevant to the objective. Searches were carried out on the database PubMed, by using the title term "male breast cancer". Results: The majority of male patients present with a painless, firm, subareolar lump. Experience of male breast imaging is good but limited. However, there is no definitive therapeutic algorithm. Men are often treated with mastectomy instead of breast conserving surgery and mostly tamoxifen is used as an adjuvant therapy. The most important prognostic factors are tumor size and lymph node status in the armpit. Conclusion: More increased awareness and further research are needed to improve the diagnosis and treatment of this disease.

show abstract

Value of mammography and breast ultrasound in male patients with nipple discharge

Cited by 27 publications

References 18 publications

Overuse of Imaging the Male Breast-Findings in 557 Patients

Overuse of Imaging the Male Breast-Findings in 557 Patients

ACR Appropriateness Criteria ® Evaluation of Nipple Discharge

Male Breast Cancer Clinical Features, Risk Factors, and Current Diagnostic and Therapeutic Approaches

Contact Info

Product

Resources

About