Role of imaging in gynaecomastia: results of a Royal College of Radiologists Breast Group Annual Scientific Meeting 2009 survey

Introduction

Gynaecomastia is a benign enlargement of male breast tissue that has no proven excess risk of breast cancer. Clinical evaluation is required to exclude breast cancer, but the role of imaging in the male breast is unclear. Our aim was to determine practice in other units, review literature and formulate informed and realistic departmental guidelines.

Methods

A questionnaire was created, and copies placed on delegates’ seats. Descriptive statistics applied.

Results

Of approximately 160 delegates, 90 questionnaires were returned from at least 58 different units. Delegates reported (estimated) greater than 864.75 years collective experience, each performing (on average) 4.3 male breast assessments per month. Sixty-five per cent (58/89) of delegates that responded reported routine imaging in clinically typical gynaecomastia, rising to 89% (79/89) in clinically typical unilateral gynaecomastia. However, 78% (68/87) of responding delegates agreed with the statement ‘Imaging is not necessary in cases of clinically typical gynaecomastia’. Three delegates reported experiencing a case of ultrasonically typical gynaecomastia that subsequently proved to be breast cancer. Imaging protocol and biopsy practice varied greatly between units. Delegates volunteered concerns that the NHS breast service is inequitable between males and females, and that guidelines were needed to rationalise imaging.

Conclusions

Based upon questionnaire findings and literature review, guidelines have been now been drawn up in our unit. There is great variation evident in UK gynaecomastia imaging practice. National discussion and agreement on evidence-based guidelines could help rationalize use of precious NHS resources and reduce imaging of this benign condition.