title: Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia.
abstract: OBJECTIVE
  To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography.
  
  
  METHODS
  Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy.
  
  
  RESULTS
  A total of 353 mammograms were obtained from 327 unique patients (ages 18-95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses.
  
  
  CONCLUSIONS
  Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management.
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Radiology, Hospital of University of Pennsylvania, 3400 Spruce Street, Philadlephia, PA 19104, USA. Electronic address: howard_chen@post.harvard.edu.
authors.forename: Po-Hao
authors.initials: PH
authors.lastname: Chen
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Beth Israel Deaconess Medical Center, Department of Radiology, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: pslanetz@bidmc.harvard.edu.
authors.forename: Priscilla J
authors.initials: PJ
authors.lastname: Slanetz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018567:Breast Neoplasms, Male / Q000150:complications / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006177:Gynecomastia / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods*; D055815:Young Adult
keywords: Gynecomastia; Male breast neoplasm; Mammography; Ultrasonography