CHICAGO – Mammography should remain the primary diagnostic tool for detecting breast cancer in symptomatic male patients, and there was no added value to incorporating ultrasound as part of the initial exam, according to researchers here. Among 360 patients, 15 cancers were diagnosed by mammography, for a cancer detection rate of 41.7 per 1,000. Of the 278/399 (69.7%) cases evaluated with ultrasound after mammography, no additional cancers were identified, reported Eric Blaschke, MD, of Milwaukee Radiologists Ltd, in Wauwatosa, Wis., and colleagues in a poster presentation at the Radiological Society of North America annual meeting.

"We didn't find that use of ultrasound in male breast cancer was useful in detecting new cancers," Blaschke reiterated to MedPage Today. "I don't think ultrasound is necessary in these patients to detect cancer. We had between 2 and 10 years follow-up with these patients and we found no additional cancers."

"When there is a cancer in these patients it shows up rather easily with mammography," he added. He explained that male patients usually presented at the clinic after finding a sore or tender area, or a lump, in the breast region.

Anja Maibaum, MD, of the Poole Hospital NHS Foundation in Bournemouth, England told MedPage Today that she agreed with Blaschke and colleagues's conclusion. "We have an experience with more than 800 men suspected of having male breast cancer and we found the 45 or so cancers just with the use of mammography," said Maibaum, who was not involved in the current study.

Blaschke's group conducted the study while the former was a fellow at Massachusetts General Hospital (MGH) in Boston. "The American College of Radiology [ACR] Appropriateness Criteria provide strong support for diagnostic mammography as the initial examination in the symptomatic male >25 years of age,, but are less clear in the role of ultrasound in this clinical setting," the authors wrote.



For this retrospective study, they evaluated MGH records from March 2006 to March 2015. Each breast with more than one focal area of clinical concern was designated as a case. Outcomes were determined by imaging, biopsy, or any pathology in the hospital tumor registry within a minimum of 12 months follow-up.

Performance measures were defined according to the ACR BI-RADS (fifth edition), the authors explained.

The mean age of 360 patients was 52.5. The majority (92.2%) were assessed as BI-RADS 1 or 2, while 3.8% were BI-RADS 3, and 5% were BI-RADS 4 or 5 by mammography. There were 10 cases of invasive ductal carcinoma, one of invasive lobular carcinoma, and four cases of ductal carcinoma in situ.

Mammography turned in a sensitivity of 100%, a specificity of 99.2%, a positive predictive value of 83.3%, and a negative predictive value of 100%.

Of the nine cases with negative imaging assessment that underwent biopsy based on clinical assessment, no cancers were diagnosed, but other diagnoses included gynecomastia, fat necrosis, fibrosis, and papilloma.

"Sonography yielded no additional cancers, and excluded one false positive," Blaschke said. "In my practice now, if we have a negative mammogram or a benign finding, we don't think it is necessary to do an ultrasound," he said.

However, he suggested that in the rare case of a man with dense breasts, tomosynthesis or ultrasound could be used. Also, ultrasound may be more useful as a method to guide biopsy, the authors noted.

Stamatia Destounis, MD, of the University of Rochester Elizabeth Wende Breast Clinic in Rochester, N.Y., also agreed that mammography is sufficient to diagnose symptomatic male breast cancer.

"These cancers do pop right out in the [mammographic] scans," she told MedPage Today. "The tissue is usually fatty, which is very easy to see through. It is not usually dense, like in many women who have dense breasts." Ultrasound may be better reserved for women with dense breast tissue, she added.

Destounis added that "we do use ultrasound in performing the biopsy ... to help us guide the needle biopsy."