title: ACR Appropriateness Criteria Evaluation of the Symptomatic Male Breast.
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.
authors.affiliation: Rhode Island Hospital, Providence, Rhode Island. Electronic address: mmainiero@lifespan.org.
authors.forename: Martha B
authors.initials: MB
authors.lastname: Mainiero
authors.affiliation: Rhode Island Hospital, Providence, Rhode Island.
authors.forename: Ana P
authors.initials: AP
authors.lastname: Lourenco
authors.affiliation: Radiology Imaging Associates/Invision Sally Jobe Breast Centers, Greenwood Village, Colorado.
authors.forename: Lora D
authors.initials: LD
authors.lastname: Barke
authors.affiliation: University of Cincinnati, Cincinnati, Ohio.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Argus
authors.affiliation: Bay Area Breast Surgeons, Oakland, California.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bailey
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: Selin
authors.initials: S
authors.lastname: Carkaci
authors.affiliation: Emory University Hospital, Atlanta, Georgia.
authors.forename: Carl
authors.initials: C
authors.lastname: D'Orsi
authors.affiliation: The University of Mississippi Medical Center, Jackson, Mississippi.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Green
authors.affiliation: Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
authors.forename: Susan O
authors.initials: SO
authors.lastname: Holley
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Jokich
authors.affiliation: University of Cincinnati, Cincinnati, Ohio.
authors.forename: Su-Ju
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: University of Cincinnati, Cincinnati, Ohio.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Mahoney
authors.affiliation: New York University, Clinical Cancer Center, New York, New York.
authors.forename: Linda
authors.initials: L
authors.lastname: Moy
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Priscilla J
authors.initials: PJ
authors.lastname: Slanetz
authors.affiliation: North Shore University Hospital, Manhasset, New York.
authors.forename: Sunita
authors.initials: S
authors.lastname: Trikha
authors.affiliation: University of Miami, Miami, Florida.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Yepes
authors.affiliation: Emory University Hospital, Atlanta, Georgia.
authors.forename: Mary S
authors.initials: MS
authors.lastname: Newell
mesh_terms: D001941:Breast Diseases / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D006801:Humans; D008297:Male
keywords: Appropriateness criteria; breast cancer; gynecomastia; male breast