Can a breast ultrasound be ordered in a male?

From the Guidelines

Yes, a breast ultrasound can be ordered for male patients, particularly those under 25 years old with an indeterminate breast mass, as recommended by the American College of Radiology 1.

Key Points to Consider

• Breast ultrasound is a useful diagnostic tool for evaluating breast symptoms in males, including palpable masses, breast pain, and gynecomastia.
• The procedure is non-invasive and does not involve radiation, making it a safer option for diagnostic purposes, especially in younger males.
• According to the American College of Radiology, ultrasound is the initial recommended imaging study for men under 25 with an indeterminate breast mass 1.
• For men over 25, mammography or digital breast tomosynthesis is recommended as the initial imaging study for an indeterminate breast mass or if the physical examination is suspicious for male breast cancer 1.

Clinical Considerations

• Male breast cancer is rare, but it can occur, and early detection is crucial for better treatment outcomes.
• Gynecomastia is the most common cause of breast symptoms in males, but it is not a risk factor for male breast cancer 1.
• A thorough clinical evaluation, including a physical examination, is essential to determine the need for imaging studies in males with breast symptoms.

Imaging Recommendations

• Ultrasound is a valuable tool for characterizing breast lesions and guiding biopsies in males, especially when the mammogram is indeterminate or suspicious 1.
• The choice of imaging modality depends on the patient's age, clinical presentation, and the suspected underlying cause of the breast symptoms.

From the Research

Breast Ultrasound in Males

• A breast ultrasound can be ordered in a male, particularly when there is a clinical abnormality such as breast enlargement or tenderness, a palpable mass, nipple skin changes, or nipple discharge 2.
• The initial imaging evaluation of a finding in the male breast is typically performed with mammography, and sonography is frequently used as an adjunct to mammography 2, 3.
• However, in younger males (<25 years), targeted ultrasound may be the initial imaging modality of choice 4.
• The use of mammography and ultrasound in the evaluation of male breast disease can help differentiate between benign and malignant conditions, such as gynecomastia and breast cancer 3, 5.

Indications for Breast Ultrasound in Males

• Palpable breast mass or lump 3, 5, 6
• Breast enlargement or tenderness 2
• Nipple skin changes or nipple discharge 2
• Suspicious findings on mammography 3, 4
• Incompletely imaged or occult findings on mammography 4

Diagnostic Approach

• Clinical evaluation, including physical examination and medical history 3, 5
• Mammography, particularly in males ≥25 years 4
• Targeted ultrasound, particularly in males <25 years or when mammography is inconclusive 4, 6
• Biopsy for suspicious findings or when imaging results are inconclusive 3, 4, 6