title: The diagnostic value of clinical examination and imaging used as part of an age-related protocol when diagnosing male breast disease: an audit of 1141 cases from a single centre.
abstract: Triple assessment in men varies, possibly in response to currently published non-specific guidance. The study aims to assess the efficacy of triple assessment as part of an age related protocol currently used in the clinical setting. 1141 referrals between 01.01.01 and 31.12.09 were evaluated. Patient age ranged from 29 to 89 years. Mammography (M) was performed in men ≥35 years. Sensitivity for clinical examination (CE) was 64.0%, M 77.8%, US 92.0%. 25 cancers were diagnosed, 24 aged >40 years, 1 aged 29. 2 presented with nipple discharge. The cancer <40 years was diagnosed with CE and US, all others had suspicious CE and/or M necessitating US and biopsy. We suggest a protocol incorporating mammography in men ≥40 years would capture all cancers. Combined specificities approaching 100% suggest men >40 years scored benign after CE and M warrant no further assessment. Bloody nipple discharge is a suspicious sign and the reassurance of non-bloody discharge should be treated with caution.
authors.affiliation: Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, UK. Kathryn.taylor@addenbrookes.nhs.uk
authors.forename: Kathryn
authors.initials: K
authors.lastname: Taylor
authors.forename: Victoria
authors.initials: V
authors.lastname: Ames
authors.forename: Matthew
authors.initials: M
authors.lastname: Wallis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018567:Breast Neoplasms, Male / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002648:Child; D006801:Humans; D008297:Male; D008327:Mammography; D008485:Medical Audit; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult