Is adding vascularity and elastography adjunct to B-mode ultrasound useful in distinguishing male breast carcinoma and gynecomastia?

Abstract

Purpose: Male breast cancer (MBC) is a relatively rare disease. It is important to distinguish it from gynecomastia, which is close in terms of the predominant age and symptoms. The aim of this study was to investigate ultrasound findings with color Doppler imaging and elastography of MBC and gynecomastia. Subjects and Methods: Of male patients with breast symptoms who had undergone ultrasound evaluation between January 2000 and October 2019, the subjects of the study were 92 patients who were diagnosed with MBC or gynecomastia. The morphology was classified into nodular, dendritic, and diffuse glandular; the vascularity on color Doppler imaging was visually classified into four grades; and the elasticity evaluation was divided into five grades using the Tsukuba elasticity score. We compared whether there was a significant difference in color Doppler imaging and elastography between MBC and gynecomastia for each morphology. Results and Discussion: There were six MBCs and 86 gynecomastias. All MBCs appeared as nodular. Gynecomastia was nodular in 28 cases (32.6%), dendritic in 17 cases (19.8%), and diffuse glandular in 41 cases (47.7%). On color Doppler imaging, the evaluation was hypervascular or vascular in 5/6 cases (83.3%) of MBC and 21/34 cases (61.8%) of gynecomastia. There was no significant difference between the two groups (P＝0.399). As for elastography evaluation, MBC scored 5 in 3/5 cases (60%). For gynecomastia, 46/49 patients (93.9%) scored 1 and 2, showing a significant difference between the two groups (P<0.005). Nodular and dendritic gynecomastia was found in 10/15 cases (66.7%), and 8/11 cases (72.7%) had high blood flow, but 35/41 diffuse glandular cases (85.4%) were diagnosed without using vascularity and elastography. The hardness evaluation was not related to morphological characteristics. Conclusion: Combining B-mode ultrasound with elastography is useful for distinguishing MBC from gynecomastia.