Evaluation of fine-needle aspiration cytology of breast masses in males.

BACKGROUND

The reliability of fine-needle aspiration cytology (FNAC) of breast masses in males could be compromised by lack of experience because breast carcinoma is rare in males and FNAC is not often used. In addition, FNAC of the more often encountered gynecomastia may lead to overdiagnosis. Therefore, in the current study the authors evaluated their experience with FNAC of breast masses occurring in males.

METHODS

A total of 153 FNACs of the male breast obtained between 1985 until the end of 2000 were retrieved from the electronic files of the study institution. A total of 141 FNACs were taken from unilateral lesions in men age > 24 years, the group of men believed to be most at risk for breast carcinoma. Histologic follow-up was retrieved from the same files and was available for 72 FNACs. For specimens without histologic follow-up the nationwide pathology database was consulted and no cases of breast carcinoma were found.

RESULTS

The inadequate rate was 13%. When inadequate FNACs were included in the calculations, the sensitivity was found to be 87% and the specificity 78%. When the inadequate FNACs were excluded from the calculations the sensitivity was reported to be 100% and the specificity 89%. The positive predictive value of a diagnosis of malignancy was 100%. During the study period the authors' institution examined approximately 10,000 FNAC specimens from male and female breasts and 399 resection specimens from the breasts of men age > 24 years with unilateral lesions. In this last group, preoperative FNAC reduced the benign-to-malignant ratio from 19.8:1 to 3.5:1.

CONCLUSIONS

FNAC of the male breast is a reliable procedure in a setting in which sufficient numbers of FNACs of the breast are examined. The authors believe FNAC should be used more often in the preoperative evaluation of breast lesions occurring in males.