What is the role of radiography in male breast cancer imaging?

Updated: Apr 11, 2019
  • Author: Lars J Grimm, MD, MHS; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

On mammography, male breast cancer is typically retroareolar as it arises from the central ducts. Gynecomastia will always originate in a subareolar position, although the distribution may extend away from the nipple.  An asymmetry with the morphology of gynecomastia that does not involve the subareolar breast is thus suspicious.

Masses are most commonly high density with an irregular shape. [23] Margins are usually spiculated, lobulated, or microlobulated.

Calcifications are observed less commonly than in female breast cancer and, when found, are coarser in appearance. Benign breast calcifications in men are uncommon, with the exception of vascular calcifications and fat necrosis.

Axillary adenopathy may be observed as well. [35, 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. [26]  

Bilateral mammography should always be obtained to help in the evaluation of the baseline breast architecture.  Almost all cases of gynecomastia will be bilateral, although typically asymmetric; thus, comparison with the contralateral side can aid in differentiating breast cancer from gynecomastia.

See the image below.

A partially circumscribed retroareolar mass in a m A partially circumscribed retroareolar mass in a male with suspicious microcalcifications; this is known breast cancer.

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