Ultrasonographic features of male breast disease

Purpose: To describe the ultrasonographic features of male breast disease. Material and methods: Between December 2006 and October 2015, ultrasound examinations were performed in 600 male patients who presented with breast enlargement, pain, and/or lump. Of these patients, the ultrasonographic features of 136 histopathologically proven male patients were retrospectively evaluated. Breast Imaging Reporting and Data System (BI-RADS) category assessments were recorded for each ultrasound examination. Results: The final diagnoses were: 9 primary breast cancer, 113 gynecomastia, 7 lipoma, 6 chronic mastitis, 1 fibroadenoma. Of 136 cases, 118 lesions (86.8%) were classified as BI-RADS category 2, 5 lesions (3.7%) were classified as BI-RADS category 3, 13 lesions (9.6%) were classified as BI-RADS 4 or BI-RADS 5. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detection of malignant breast masses of BI-RADS ultrasound were 100%, 96.9%, 69.2%, 100%, 90.4% respectively. On sonography, eight of 9 cancers were solid and hypoechoic, one was complex mass with mixed solid and cystic components. The shape of the malignant masses was irregular (n = 8) or oval (n = 1). The margins were well-defined in 1, spiculated in 3, microlobulated in 5 of the malignant masses. Color Doppler flow imaging (CDFI) revealed hypervasularity in 5 masses, moderate vascularity in one mass, mild vascularity in 2 masses. All the malignant masses were corresponded to BI-RADS category 4 or 5. The presence of abnormal axillary lymph nodes was noted in five cases by sonography. The five patients had axillary lymph node involvement by final pathology. The distribution of the sonographic patterns of gynecomastia were 28 nodular (28/113; 24.8%), 30 dendritic (30/113; 26.5%), 55 diffuse glandular (55/113; 48.7%). Conclusions: Male breast has a wide spectrum of diseases. Ultrasonography is useful for differentiating male breast cancer from benign diseases.