Mammography, sonography characterize breast cancer in men

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Mammography and sonography findings may help doctors identify and appropriately treat breast cancer in men, according to a study performed at the University of Texas M.D. Cancer Center in Houston, which appears in the December issue of the American Journal of Roentgenology.

Male breast cancer accounts for less than 1 percent of all breast cancers and "a large number of men with breast cancer do not undergo imaging prior to treatment either because mammography is not heavily advertised in the male community or because men also may be socially conscious about that part of their anatomy," said Wei Tse Yang, MD, lead author of the study.

Male patients from a single pathology database with the histologic diagnosis of breast cancer who had undergone preoperative mammography or sonography were included in the study. The mammograms and sonograms were retrospectively reviewed according to the American College of Radiology BI-RADS lexicon. Patients who did not have films available but had imaging reports available for review were also included. Sonograms of the regional nodal basins, including axillary, infraclavicular, internal mammary and supraclavicular regions, were noted. Histopathology subtype of breast cancer and axillary nodal status were documented.

A total of 57 patients with imaging and 187 patients without imaging were included. The median age was 62 years. Forty-nine patients underwent both mammography and sonography; six, mammography alone; and two, sonography alone. They reported that 95 percent of patients presented with a palpable mass and 4 percent with nipple inversion.

At mammography, 69 percent of cancers showed a mass; 29 percent, mass with microcalcifications; and 2 percent, microcalcifications. Gynecomastia was identified in 40 percent of the patients. Mammographic features included an irregular mass with spiculated or indistinct margins. Calcifications were typically pleomorphic and segmental. Sonographic features were typically an irregular mass with microlobulated margins. Axillary nodal involvement was present in 47 percent of patients. Most cancers were ductal carcinoma, either invasive or in situ, according to the researchers.

“The findings show that breast cancer in men most commonly presents itself as a mass with an irregular shape and spiculated margins that may or may not have calcifications. Many men in the study, 47 percent, also had cancer which had spread to the armpit,” Yang said.