The diagnostic accuracy of mammography in the evaluation of male breast disease.

BACKGROUND: The role of mammography in the evaluation of male patients presenting with breast disease is controversial. This controversy is a function of the lack of specific data concerning the diagnostic accuracy of mammography when used in this clinical setting. The purpose of this study was to define the diagnostic accuracy of mammography in the evaluation of male breast disease. METHODS: One hundred and four prebiopsy mammograms from 100 patients with tissue diagnoses were read blindly by two independent radiologists, and placed into one of five predetermined categories: definitely malignant, possibly malignant, gynecomastia, benign mass, and normal. Radiologic/pathologic correlation was performed and the sensitivity (Sn), specificity (Sp), positive (Ppv) and negative predictive value (Npv), and accuracy (Ac) for each of the mammographic diagnostic category determined. RESULTS: The pathologic diagnoses were 12 cancers, including 1 patient with bilateral breast cancer, 70 cases of gynecomastia, 16 benign masses, and 6 normals. The accuracy data for the mammographic diagnostic categories are as follows: malignant (combined definitely and possibly malignant), Sn 92%, Sp 90%, Ppv 55%, Npv 99%, Ac 90%; and overall benignity (combined gynecomastia, benign mass, and normal), Sn 90%, Sp 92%, Ppv 99%, Npv 55%, Ac 90%. Six cancers (50%) coexisted with gynecomastia. CONCLUSIONS: Mammography can accurately distinguish between malignant and benign male breast disease. Although not a replacement for clinical examination, its routine use could substantially reduce the need for biopsy in patients whose mammograms and clinical examination suggest benign disease.     

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??Value analysis of different clinical and imaging features in the diagnosis of benign and malignant nipple discharge HUANG Jia-hui??CHEN Xiao-song, WU Jia-yi, et al. Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Corresponding author: SHEN Kun-wei, E-mail: kwshen@medmail.com.cn
Abstract Objective To analyze the value of different clinical and imaging features in the diagnosis of benign and malignant nipple discharge. Methods The clinical data of 233 patients treated with surgery for nipple discharge from January 2011 to February 2016 in Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. A total of 233 cases without palpable mass were enrolled in the analysis. Thirty-three patients (14.2%) were diagnosed as breast cancer, and the other 200 patients (85.8%) were diagnosed as benign disease. The sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mammogram, ultrasound, MRI and their combination in predicting malignant disease were calculated. Results Patients with bloody nipple discharge (P=0.008), with suspicious calcification on mammography (P<0.001)??with segmental enhancement (P=0.003) or with washout-pattern kinetic curve (P=0.023) on MRI had higher risk of breast cancer. The sensitivity of mammography in diagnosing breast cancer was 57.6%, significantly lower than that of ultrasound (87.9%,P=0.012) and MRI (93.9%??P=0.001). The sensitivity of mammography combined with ultrasound or with MRI was 90.9% and 100% respectively, significantly higher than that of mammography alone (P=0.004, P<0.001) .Conclusion Bloody nipple discharge, with suspicious calcification on mammography, with segmental or with washout-pattern kinetic curve on MRI are risk factors for predicting breast cancer in patients with nipple discharge without palpable disease. The sensitivity of breast cancer can be elevated with ultrasound or MRI comparing with mammography alone.     

不同临床及影像学特征对良恶性乳头溢液疾病鉴别诊断价值分析

目的 探讨不同临床及影像学特征对良性及恶性乳头溢液疾病的诊断价值。 方法 回顾性分析2011年1月至2016年2月上海交通大学医学院附属瑞金医院因乳头溢液行手术治疗的233例病人的临床资料。乳腺癌33例（14.2%）,乳腺良性疾病200例（85.8%）。分析不同临床及影像学特征病人良性及恶性乳头溢液的检出率,计算乳腺X线摄影、乳腺超声、乳腺MRI及联合检查对乳腺癌诊断的灵敏度。 结果 血性溢液（P=0.008）、乳腺X线摄影伴可疑恶性钙化（P<0.001）、MRI表现为段样强化（P=0.003）、流出型时间-信号强度曲线（P=0.023）的病人乳腺癌检出率明显增高,差异有统计学意义。乳腺X线摄影对恶性乳头溢液诊断的灵敏度较低（57.6%）,劣于超声检查（87.9%,P=0.012）及MRI检查（93.9%,P=0.001）。乳腺X线摄影联合超声或MRI诊断的灵敏度分别为90.9%及100.0%,显著高于单用乳腺X线检查（P=0.004,P<0.001）。结论 对于不伴肿块的乳头溢液,血性溢液、乳腺X线摄影伴可疑恶性钙化、MRI段样强化、时间-信号强度曲线为流出型的病人患乳腺癌的风险较高。乳腺X线摄影对乳头溢液潜在恶性病变的检出率较低,联合超声或MRI检查可提高检出率。     

Radio‐guided and clip‐guided preoperative localization for malignant microcalcifications offer similar performances in breast‐conserving surgery

Obtaining a tailored breast resection is challenging in microcalcifications detected on screening mammography, and an accurate localization is required. The aim of this study was to compare the efficacy of radio‐guided localization (ROLL) versus ultrasound localization of a titanium clip with collagen (TCC) in terms of clear margins, re‐intervention rates, excess of resected breast tissue, and operative times in pure malignant microcalcifications detected on screening mammography. Two hundred and twenty‐one consecutive patients with malignant microcalcifications detected on screening mammography from a tertiary breast unit were reviewed: 177 patients were localized by TCC and 44 patients by stereotactic ROLL. A propensity score‐matched analysis was performed, followed by a logistic regression model, to avoid selection bias. Adequacy of resection was expressed as the calculated resection ratio considering lesion size. No differences were found in clear margins with ROLL versus TCC (77.3% vs 81.8%, adjusted OR 2, P = 0.27). Re‐operation rates were similar, being 11.3% with ROLL and 7.4% with TCC (P = 0.627). Mean resection volume was 46.2 cm³ with ROLL versus 54.2 cm³ with TCC (P = 0.222). Adjusted mean calculated resection ratio was 1.8 with ROLL and 2.1 with TCC (P = 0.38). Surgery time was longer with TCC compared to ROLL (69.6 vs 52.7 minutes, P < 0.0001). ROLL and TCC are equally effective to excise malignant microcalcifications with clear margins, providing similar re‐intervention rates and resection volumes.     

Unilateral male breast masses: cancer risk and their evaluation and management

Breast cancer is an uncommon cause of breast enlargement in the adult male. Overall, it accounts for <1 per cent of all male cancers. Although most male breast carcinomas are clinically apparent, distinguishing early breast cancer from gynecomastia, the most common cause of male breast enlargement, is considered a difficult task. To overcome this difficulty, many surgeons proceed directly to surgery as their initial diagnostic test. Although appropriate in some cases, the infrequent occurrence of male breast cancer and the diagnostic accuracy of mammography and fine-needle aspiration cytology suggest a modification of our present management. The aim of this study was to assess the incidence of breast cancer in men with unilateral breast masses and to propose a treatment algorithm for unilateral male breast masses. The medical records of 36 male patients who underwent subcutaneous mastectomy for a unilateral breast mass at the Buffalo Veterans Administration Medical Center between 1989 and 1996 were retrospectively reviewed. Data was collected on a standard data form. The median age was 63-years-old (range, 22-82). Gynecomastia was diagnosed in 30 patients (83%), lipoma in 4 patients (11%), invasive breast cancer in 1 patient (3%), and melanoma in situ in 1 patient (3%). Of the 30 patients with gynecomastia, 60% (18 patients) gave a history of a medical condition or use of medications known to cause gynecomastia, compared with 16 per cent (1 of 6) of the patients without gynecomastia (P = 0.08). Half of the patients with gynecomastia presented with an asymptomatic mass compared with 67 per cent of the patients without gynecomastia (P = not significant). The median duration of symptoms for patients with gynecomastia was 3 months. Men with unilateral breast masses have a low incidence of breast cancer. A male patient with a palpable unilateral breast mass consistent with gynecomastia on the basis of historical, physical and mammographic findings does not require surgical biopsy unless other clinical indications prevail. Lack of symptoms (pain) related to the mass is probably not helpful in deciphering gynecomastia from breast cancer.     

Specimen Radiographs Assist in Identifying and Assessing Resection Margins of Occult Breast Carcinomas

Abstract: For carcinoma specimens with non‐grossly identifiable lesions such as microcalcifications, difficulties may be encountered in locating these abnormalities and sampling the margins that are at risk. This is magnified in the case of skin‐sparing procedures where the margin is a much greater surface area and is the operation of choice in patients with diffuse microcalcifications and/or multifocal in situ disease. The objective of this study was to determine the efficacy of specimen radiographs of mastectomy in identifying occult carcinoma associated with microcalcifications and assessing the resection margins. We reviewed the histology and corresponding specimen radiographs of 16 patients with diffuse and widespread microcalcifications and who underwent skin‐sparing mastectomy. After the specimens were serially sectioned, specimen radiographs of each section of the specimens were obtained with digital mammography equipment. Findings in the specimen radiographs were used to direct the histologic sampling of the specimens. On gross examination, two (12.5%) mastectomy specimens had identifiable discreet masses; the lesions were 4 and 7 mm, respectively. Histologic examination revealed the presence of carcinoma in 13 (81%) cases; seven with both infiltrating and in situ carcinoma and six with in situ carcinoma alone. The remaining three patients demonstrated only changes of biopsy site without any residual carcinoma. Microcalcifications were associated with in situ carcinoma in all malignant cases. Among the 12 cases with microcalcifications present at or within 2 mm of the margins, in situ carcinoma was present at the margins in three cases and located within 2 mm of the margins in two cases. All margins were negative in all cases with microcalcifications that were at least 1 cm away from the resection margins. The average number of tissue blocks examined was 16.6 ± 5.4. The average number of tissue blocks sampled among randomly selected mastectomy specimens was 15.2 ± 5.4. There was no statistically significant difference in the number of blocks between mastectomy cases with specimen radiographs taken and those without (t‐test). Our study suggests that specimen radiographs may assist in identifying occult breast carcinoma associated with microcalcifications and assessing the resection margins without increased sampling.     

Ultrasonographic assessment of male breast diseases

Although rare and accounting for less than 1% of all breast cancers, the incidence of breast cancer in men has increased by 26% over the past few decades. Very little has been reported on the sonographic appearance of benign and malignant male breast conditions. The aim of this study was to describe the ultrasonographic features of male breast disease and the value of ultrasound in the evaluation of male breast disease. Between December 2006 and October 2014, ultrasound examinations were performed in 560 male patients presenting with enlargement of, pain in, and/or a lump in the breast. One hundred and thirty‐six patients (24.3%) underwent surgical excision, and 424 patients (75.7%) were diagnosed by ultrasound. Their ultrasonographic features were retrospectively evaluated. The final diagnoses were gynecomastia (n = 537), primary breast cancer (n = 9), lipoma (n = 7), chronic mastitis (n = 6), and fibroadenoma (n = 1). Of the 560 lesions, 356 (63.6%) were classified as Breast Imaging Reporting and Data System (BI‐RADS) category 2, 191 (34.1%) were classified as BI‐RADS category 3, and 13 (2.3%) were classified as BI‐RADS 4 or 5. The sensitivity, specificity, PPV, NPV, and accuracy of the detection of malignant breast masses according to ultrasound were 100%, 99.3%, 69.2%, 100%, and 97.7% respectively. The sonographic patterns of gynecomastia were nodular (n = 131, 24.4%), dendritic (n = 50, 9.3%), and diffuse glandular (n = 356, 66.3%). Color Doppler flow imaging revealed hypervascularity in five of these malignant masses, moderate vascularity in two of the masses, and mild vascularity in the remaining two masses. Other diseases included in the study are also described. Ultrasonography (US) is useful in the diagnosis of male breast diseases, especially in differentiating cancer from benign lesions.     

超声检测乳腺癌微小钙化的影响因素及与钼靶X线摄影的对比

【摘要】〓目的〓比较超声与钼靶X线摄影检测乳腺癌微小钙化的一致性,探讨影响超声检测乳腺癌微小钙化的影响因素。方法〓87例乳腺癌行超声及钼靶X线摄影检查,分析二者的乳腺病灶及微小钙化的特点,比较二者检测的一致性,分析超声检测微小钙化的影响因素。结果〓超声对病灶的显示率及诊断恶性的准确率均高于钼靶(χ2=9.911,P=0.002)。二者在微小钙化的检出方面无统计学差异(P>0.05),具有较高的一致性(k=0.652)。以钼靶显示微小钙化作为标准,超声检测微小钙化的敏感度为82.1%,特异度为83.3%,假阳性率16.7%,假阴性率为17.9%。钼靶上微小钙化的大小及密集程度影响其超声检测(P<0.05)。结论〓超声较钼靶X线摄影能更敏感地检测及诊断乳腺恶性病变;超声能有效地检测乳腺癌微小钙化,但易受微小钙化的大小及密集程度的影响。     

Technetium-99m sestamibi scintimammography complements mammography in the detection of breast cancer

Mammography remains the technique of choice for the detection of early breast cancer. The sensitivity of mammography is 85%, but is decreased in patients with dense breasts. Sestamibi scintimammography (SCM) has been suggested as an adjunctive modality to improve the detection of breast cancer. We conducted a study to determine the impact of SCM in patient management. A prospective study was conducted in 95 patients presenting with palpable masses and/or abnormal mammography scheduled for biopsy. Injection of 20-30 mCi of technetium-99m (Tc-99m) sestamibi into a pedal vein was performed. Ten-minute images of the breast and axilla were obtained in multiple projections. The mammography and SCM were correlated with pathology and clinical findings. The median age was 44 years (range 28-86 years). The total number of lesions was 104, as eight patients had bilateral lesions and one patient had two lesions in the same breast. Fifty-nine patients presented with palpable lesions and 45 patients with nonpalpable lesions (42 with abnormal mammography only and 3 with nipple discharge). A comparison of sensitivity, specificity, positive and negative predictive values, and overall accuracy of SCM and mammography were performed. The sensitivity and specificity for SCM were 83% and 83%, respectively, and for mammography were 65%, and 72%, respectively. The sensitivity and specificity for combined SCM and mammography were 87% and 94%, respectively. The p-value for mammography versus combined SCM and mammography was 0.0003 and that for SCM versus SCM and mammography was 0.0098. There were 80 (77%) benign and 24 (23%) malignant lesions. Of the 24 malignancies, SCM missed six (25%), versus eight (33%) by mammography. In two patients (9%) SCM detected malignancy in the breast that was not visualized by mammography or found on clinical examination. Sestamibi SCM improves the sensitivity of mammography and it detects up to 9% of malignancies not detected by mammography or clinical examination. This testing could impact the management of 16,500 patients in the United States every year. More studies are needed to better define its role in breast cancer detection.     

乳管镜对以病理性乳头溢液为首发症状乳腺癌诊断价值分析

目的 评估乳管镜在以病理性乳头溢液为首发症状乳腺癌中的诊断价值。方法 回顾性分析2016年8月至2019年8月中国医科大学附属第四医院（380例）和新疆塔城地区人民医院（30例）收治的共410例以病理性乳头溢液为首发症状病人的临床资料，所有病人术前均行乳管镜、超声及钼靶检查。分析乳管镜检查中与乳腺癌诊断密切相关的因素，比较不同检查方式对乳腺癌诊断的敏感度、特异度、阳性预测值及阴性预测值。结果 410例病人均接受手术治疗，并进行术后病理学诊断，其中乳腺癌31例（7.6%）。乳管镜检查结果中，良性病例与恶性病例的溢液颜色、溢液量及病灶深度差异有统计学意义（P<0.05）。乳管镜对于乳腺癌术前评估诊断的敏感度为90.3%，明显高于超声（61.3%）和钼靶检查（48.4%），三者特异度差异无统计学意义（P>0.05）。超声联合钼靶检查敏感度为71.0%，而在此基础上联合乳管镜检查可使诊断的敏感度提高至93.5%。结论 在以病理性乳头溢液为首发症状乳腺癌的诊断中，乳管镜检查的敏感度显著高于超声和钼靶，增加乳管镜检查能够显著提高乳腺癌诊断的敏感度，避免漏诊。     

乳管镜对以病理性乳头溢液为首发症状乳腺癌诊断价值分析

目的 评估乳管镜在以病理性乳头溢液为首发症状乳腺癌中的诊断价值。方法 回顾性分析2016年8月至2019年8月中国医科大学附属第四医院（380例）和新疆塔城地区人民医院（30例）收治的共410例以病理性乳头溢液为首发症状病人的临床资料,所有病人术前均行乳管镜、超声及钼靶检查。分析乳管镜检查中与乳腺癌诊断密切相关的因素,比较不同检查方式对乳腺癌诊断的敏感度、特异度、阳性预测值及阴性预测值。结果 410例病人均接受手术治疗,并进行术后病理学诊断,其中乳腺癌31例（7.6%）。乳管镜检查结果中,良性病例与恶性病例的溢液颜色、溢液量及病灶深度差异有统计学意义（P<0.05）。乳管镜对于乳腺癌术前评估诊断的敏感度为90.3%,明显高于超声（61.3%）和钼靶检查（48.4%）,三者特异度差异无统计学意义（P>0.05）。超声联合钼靶检查敏感度为71.0%,而在此基础上联合乳管镜检查可使诊断的敏感度提高至93.5%。结论 在以病理性乳头溢液为首发症状乳腺癌的诊断中,乳管镜检查的敏感度显著高于超声和钼靶,增加乳管镜检查能够显著提高乳腺癌诊断的敏感度,避免漏诊。     

Atypical gynecomastia mimicking breast malignancy on mammography,sonography, and 18F‐fluciclovine PET/CT in the setting of biochemical recurrence of prostate cancer

A 60‐year‐old man with metastatic prostate cancer presented with breast swelling for one year. Suspicious breast masses were identified in both breasts with mammography and ultrasound. Biopsy of both masses showed florid gynecomastia without malignancy. Sixteen months later, the patient underwent 18F‐fluciclovine PET/CT for biochemical recurrence of prostate cancer; this showed focal radiotracer uptake in both breasts. Repeat mammogram and ultrasound showed these areas to correspond with the previously biopsied masses, which were stable. To our knowledge, this is the first reported case of gynecomastia mimicking malignancy on 18F‐fluciclovine PET/CT.     

Lymphoma of the breast: clinical and radiologic features with pathologic correlation in 28 patients

The objective of this study was to determine the clinical and radiologic findings of lymphoma involving the breast, separately evaluating primary and secondary forms. We retrospectively reviewed the medical reports of 28 patients with lymphoma of the breast: 12 patients with primary lymphoma and 16 with secondary lymphoma. In primary lymphoma, mammography revealed a solitary mass (58.3%), multiple unilateral masses (8.3%), unilateral diffuse involvement (25%), and bilateral diffuse involvement (8.3%). The margins of masses were irregular (50%), partially defined (37.5%), and well defined (12.5%). The mean diameter of the masses was 4.6 cm. In secondary lymphoma, mammography revealed multiple masses (56.2%), solitary masses (12.5%), and diffuse unilateral breast involvement (31.2%). Their margins were irregular (18.1%), partially defined (27.2%), and well-defined (54.5%). The mean diameter of the masses was 2.8 cm. Cytologic examination ( n = 13) was demonstrative of lymphomatous involvement in all cases. We observed an association between high-grade types of malignancy and a diffuse pattern of radiologic breast involvement. Masses in primary disease tended to have less-defined margins and greater diameters than those observed in secondary cases. Cytologic examination proved to be a useful diagnostic procedure in the evaluation of secondary disease. The involvement of the breast in extranodal lymphomas does not seem to affect the prognosis of the disease.     

Wire-guided biopsies of nonpalpable breast lesions

The purpose of this study was to review the results of mammographic wire-guided biopsies of nonpalpable breast lesions and the features of the lesions in the preoperative examinations. Sixty women, mean age 50.2 years (range 31 to 74), underwent a wire-guided biopsy of the lesion. Twenty-nine patients had preoperative fine needle aspiration of the lesion. The radiographic diagnosis was correct in 33 patients (55%); 25 had breast cancer and 8 patients had a benign lesion. In 9 of the 14 patients with clustered microcalcifications in mammography and in 13 of the 15 patients with a mass noted in mammography, the cytological examination was correct. Nonpalpable mammographic masses with regular borders and normal fine needle aspiration examination do not require biopsy. In malignant mammographic appearances associated with a normal fine needle aspiration examination, biopsy of the lesion should always be done.     

乳管内乳头状病变的临床分析：附1?211例报告

目的：探讨乳管内乳头状病变的临床病理特征及诊断方法。 方法：采用回顾性方法,对1?211例不同类型乳管内乳头状病变的年龄分布、乳头溢液与乳房肿块情况、病理及影像学检查结果进行分析。 结果：1?211例患者中,乳头状瘤874例,乳头状瘤病231例,乳头状癌106例;恶性病变患者平均年龄大于良性病变患者（P<0.01）,31~50岁为乳头状瘤及乳头状瘤病的高发年龄;16.0%患者有乳腺疾病手术史,乳头状瘤病患者中先后多次手术及同时双侧手术者明显多于乳头状瘤与乳头状癌患者（P<0.05）;67.8%患者有不同性质的乳头溢液,乳头状癌患者中溢液病例少于良性病变患者,但血性溢液明显多于良性病变患者（P<0.05）;约80%的良性病变术中可见肿块,恶性者术中均可见肿块,乳头状瘤病患者中伴有中-重不典型增生者明显多于乳头状瘤（P<0.05）,肿块>1.0 cm时常伴有中-重不典型增生,乳头状癌患者肿块平均最大径（1.93±0.78）cm;导管造影及导管镜检查对良性病变诊断的准确率高于彩色B超和钼靶（P<0.05）。 结论：不同类型乳管内乳头状病变有一些共同表现,也有各自特征,掌握这些特征有利于临床正确诊断及合理的治疗。     

On the neglected entity of unilateral gynecomastia

Although there are many articles in the literature on the etiology, classification, and management of gynecomastia, the entity of unilateral gynecomastia has not received much attention. In this article, 15 consecutive males (seen over a 10-year period) with unilateral gynecomastia were retrospectively reviewed. The study showed the unique presentation in this group of patients. One third of the patients (n = 5) had "cancer phobia" and were worried either because of the presence of a mass (n = 2) or because of the unilaterality of their disease (n = 3). The study also showed the predominance of true (glandular) gynecomastia, and this has also been observed in other cases of unilateral involvement in the literature. All patients underwent preoperative mammography. Mammographic findings were consistent with gynecomastia in all patients, including the 2 patients with concurrent breast masses. All patients underwent subcutaneous mastectomy, and histologic examination confirmed the diagnosis. Finally, the literature on unilateral gynecomastia was reviewed.     

高频超声引导下乳腺钙化微创切除活检的临床研究

目的 探讨高频超声引导下乳腺钙化微创切除活检的临床应用价值.方法 2009年7月至2010年10月对66例乳腺钙化进行高频超声引导下的微创切除活检.全组病例均为女性,年龄24～61岁,中位年龄40岁.单侧乳腺钙化62例,双侧乳腺钙化4例,共70侧乳腺钙化病灶.评价钙化取出的活检成功率,采用x2检验的单因素分析和Logistic多因素回归分析,研究影响钙化微创活检的临床因素.结果 全组70侧乳腺钙化的活检成功率为72.9％ (51/70).弥散性钙化的活检成功率为65.2％( 30/46),钙化伴肿块的活检成功率为87.5％ (21/34),两者差异有统计学意义(x2=3.960,P=0.047).钙化范围＞5mm的病例活检成功率为88.9％(32/36);钙化范围≤5 mm的病例的活检成功率为55.9％ (19/34),两者差异有统计学意义(x2=9.633,P=0.002).Logistic多因素回归分析结果显示,钙化的类型和钙化的范围是影响微创活检成功率的主要因素.结论 高频超声引导下乳腺钙化微创切除活检有较好的临床应用价值,对于钙化伴肿块和钙化范围＞5 mm的病例活检的成功率更高.     

Digital Breast Tomosynthesis: A New Diagnostic Method for Mass‐Like Lesions in Dense Breasts

To compare the rates and accuracy of digital breast tomosynthesis (DBT) and 2D digital mammography (DM) for detecting and diagnosing mass‐like lesions in dense breasts. Mediolateral and craniocaudal images taken with DBT (affected breast) and DM (both breasts) of the dense breasts of 631 women were assessed independently using Breast Imaging Reporting and Data System (BI‐RADS) scores. Images were compared for detection and diagnostic accuracy for masses; sensitivity and specificity of diagnosis; false‐negative and recall rates; and clarity of display, particularly of margins and spicules. Histopathology was conducted via surgical biopsies of all patients. The detection and diagnostic accuracy rates of DBT images (84.3% and 82.3%, respectively) were significantly higher than that of DM (77.3% and 73.4%; p < 0.01, both). The sensitivity and specificity of DBT (68.1% and 95.2%) were higher than that of DM (58.8% and 86.7%), whereas the recall rate of DBT was lower (3.6% cf. 9.8%). The number of cases of benign circumscribed masses and malignant spiculated masses detected by DBT (172 and 182) was significantly higher than the number detected through DM (75 and 115; p < 0.01, both). Radiologists assigned higher BI‐RADS scores for probability of malignancy to DBT images than DM, to lesions proved malignant (p = 0.025); for benign cases, the methods were comparable (p = 0.065). Compared with DM, DBT yielded significantly higher rates of detection and diagnostic accuracy for benign and malignant masses, with greater sensitivity and specificity and lower recall rates. In addition, DBT images facilitated analysis of margins, and the rate of accuracy for judgments of malignancy probability was higher, as proved on biopsy.     

Overuse of Imaging the Male Breast—Findings in 557 Patients

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.     

The impact of mammography on breast biopsy.

To determine the efficacy of mammography in the detection of early breast carcinoma at an urban teaching hospital, the results of all breast biopsies performed between 1983 and 1987 that were preceded by mammographic examination were retrospectively reviewed. There were 503 women in this population. Malignancy was detected in 79 cases (15.7%); 21 were in situ and 58 were invasive. Among all nonpalpable malignancies, 53.0 per cent were in situ, while only 2.4 per cent of all palpable malignancies were in situ. An abnormality was found in 374 mammograms (74%), and 73 (19.5%) were malignant. The abnormality most likely to represent a malignancy (44% yield) was spiculated density, followed by clustered microcalcifications (25%), mass (22%), and asymmetric density (14%). Six malignancies were detected by biopsy for clinical indications, despite a negative mammogram (4.7% false- negative rate). The interpretation of mammograms by radiologists carried a 2.4 per cent false-negative rate. The mammographic features of mass, clustered microcalcifications, spiculations or asymmetric density should generally mandate breast biopsy, although the clinical examination should remain an important basis for management decisions. An aggressive approach toward screening mammography and breast biopsy based on mammographic criteria may enhance survival among women with breast carcinoma.