Modern approaches to the diagnosis of breast cancer: Diagnostic methods of breast pathology in the male population

The terms “male breast” and “male mammary gland” are both used in medical literature. Experimental and clinical studies demonstrate a similar origin and development of hyperplastic processes in breast in men and women, as well as common etiology and pathogenetic mechanisms of development of breast carcinoma in male and female organisms. The international standard for anatomical terminology (Terminologia Anatomica 1998) omitted the separate term “mamma masculine” because the male breast contains no unique elements but those of the female breast developed to a lesser extent. In the European and North American literature, several terms are used for breast carcinoma both in women and in men along with the Latin term “cancer mammae.” The common term in English is “breast cancer,” but with reference to men, the additional word “male” is applied. © Springer International Publishing Switzerland 2015

Ultrasound imaging of breast cancer metastases

About 47% of men with breast cancer have significant local spreading of the process by the time of first reference to the doctor (Letyagin 2006). Because of the more aggressive development of breast carcinoma in men compared with women, metastases in regional lymph nodes are expected earlier, first in the axillary region. © Springer International Publishing Switzerland 2015

Recurrent breast cancer

Studies devoted to survival analysis in men with breast carcinoma are significantly smaller than similar studies in women. In most cases, only the general survival rate is evaluated. The majority of authors agree that the prognosis in men with breast cancer is significantly worse than in women with similar disease (Dymarsky 1980; Guinee et al. 1993). The lower general survival rate in men results from an older age and later stages of the disease at the time of the diagnosis. According to the literature, the 5-year survival rate in men with breast carcinoma ranges from 36 to 66 % (Korde et al. 2010). The 10-year survival rates in patients with stage I-Ia is 91.5 %, IIb is 72.5 %, III is 44.2 %, and IV does not exceed 3.2 % (Guinee et al. 1993; Letyagin 2006). © Springer International Publishing Switzerland 2015

Ultrasound of male breast cancer

Breast carcinoma in men is a rare disease, with an incidence of 1:100,000. It is found approximately 100 times more rarely in men than in women. Breast carcinoma represents 0.2-1.5 % of all malignant tumors in men (Crichlow 1972; Ostrovskaya et al. 1988). Studies demonstrate that black men are affected more often than white men, regardless of age. The incidence of breast cancer in black men is 1.8:100,000, compared with 1.1:100,000 in white men (Anderson et al. 2004). © Springer International Publishing Switzerland 2015

Anatomy, physiology, and development of the male breast

The normal anatomy and individual features of the breast and regional lymph nodes in men should be considered during the examination. Each breast is located on the anterior surface of the chest, on the pectoral fascia and pectoralis major muscle between the parasternal and anterior axillary lines, with the nipple on the midclavicular line (Fig. 2.1). The breast level typically corresponds to the second through sixth ribs. © Springer International Publishing Switzerland 2015

Healthy breast with ultrasound

For breast ultrasound (US) of women, it is preferable that the examination be performed during certain periods of the menstrual cycle, whereas breast US examination in men does not require any special preparation or timing. The indications for breast US in men are as follows: © Springer International Publishing Switzerland 2015

Differential diagnosis of male breast cancer

The differential diagnosis of breast carcinoma with its large variety of types cannot be limited to one disease. It includes benign diseases (gynecomastia, benign tumors) and malignant processes (sarcoma, metastases of tumors of other localizations) and various inflammations. In this respect, differential imaging features of breast diseases, which indicate structure, vascularity, interrelation with surrounding tissues, and the status of regional lymph nodes, are beneficial. © Springer International Publishing Switzerland 2015

Classification of breast masses

The classification of breast tumors and differentiation of stages in men, as well as in women, is necessary for defining tactics, methods of treatment, duration of therapy, volume of surgery, follow-up strategy, and prognosis. Male breast cancer is not separately classified as an independent nosology. Existing classifications accepted for breast carcinoma in women are most often used. Some classifications of breast cancer are based on clinical and etiological features, imaging methods, and pathology to characterize the primary breast tumor, its spreading, and local and remote metastases. Some examples of clinical classifications that have been used in different countries are those proposed by Holdin in Russia and the countries of former USSR, by Holsted and Manchester in Great Britain, by Colombian in the United States, and by Steinthal in European countries. The international clinical classification based on the TNM system is now the most appropriate for breast cancer staging. © Springer International Publishing Switzerland 2015

Healthy breast with ultrasound

For breast ultrasound (US) of women, it is preferable that the examination be performed during certain periods of the menstrual cycle, whereas breast US examination in men does not require any special preparation or timing. The indications for breast US in men are as follows: © Springer International Publishing Switzerland 2015

Treatment strategies for breast diseases, types of breast surgery, the postoperative breast, and follow-up principles

Different breast diseases in men implicate different diagnostic and treatment strategies. Breast pathology is treated several ways. Unfortunately, today, there is no common view regarding the therapy of gynecomastia, inflammatory and traumatic breast diseases, benign lesions, and cancer in men. The principles of treatment of many of them are based on knowledge obtained during the treatment of women with similar pathology. Breast diseases in men are rare, and it takes a long time to collect enough data for analysis. Meanwhile, the diagnostic and treatment methods of breast diseases can change. This fact complicates the study of the treatment of male breast diseases. © Springer International Publishing Switzerland 2015