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J Am Coll Radiol. 2015 Jul;12(7):678-82. doi: 10.1016/j.jacr.2015.03.024. Epub 2015 May 19.

ACR Appropriateness Criteria Evaluation of the Symptomatic Male Breast.

Author information

1
Rhode Island Hospital, Providence, Rhode Island. Electronic address: mmainiero@lifespan.org.
2
Rhode Island Hospital, Providence, Rhode Island.
3
Radiology Imaging Associates/Invision Sally Jobe Breast Centers, Greenwood Village, Colorado.
4
University of Cincinnati, Cincinnati, Ohio.
5
Bay Area Breast Surgeons, Oakland, California.
6
Ohio State University, Columbus, Ohio.
7
Emory University Hospital, Atlanta, Georgia.
8
The University of Mississippi Medical Center, Jackson, Mississippi.
9
Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
10
Rush University Medical Center, Chicago, Illinois.
11
New York University, Clinical Cancer Center, New York, New York.
12
Beth Israel Deaconess Medical Center, Boston, Massachusetts.
13
North Shore University Hospital, Manhasset, New York.
14
University of Miami, Miami, Florida.

Abstract

Most male breast problems are benign, and men with typical symptoms of gynecomastia or pseudogynecomastia do not usually need imaging. When a differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings or when the clinical findings are suspicious for breast cancer, imaging is indicated. Mammography is useful in both identifying cancer and obviating the need for biopsy in patients for whom a benign mammographic impression confirms the clinical impression. However, because of the relationship of breast cancer to increasing age, age-based protocols that do not include mammography have been developed. For men with an indeterminate palpable mass, begin with ultrasound if the patient is <25 years of age, because breast cancer is highly unlikely. Mammography should be performed if ultrasound is suspicious. For men ≥25 years of age or having a highly concerning physical examination, usually begin with mammography; ultrasound is useful if mammography is inconclusive or suspicious. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals, and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.

KEYWORDS:

Appropriateness criteria; breast cancer; gynecomastia; male breast

PMID:
26001306
DOI:
10.1016/j.jacr.2015.03.024
[Indexed for MEDLINE]

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