Hines Stephanie L, Tan Winston, Larson Jan M, Thompson Kristine M, Jorn H Keels S, Files Julia A
Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
Geriatrics. 2008 Jun;63(6):19-24.
Breast cancer must be considered in the evaluation of breast masses in men, although various benign causes are more common, including gynecomastia and conditions of the skin and subcutaneous tissue. A patient's history may identify key features suspicious for malignancy or reassuring for benign disease. Physical examination has been documented to be as effective as mammography in distinguishing benign from malignant lesions, and both have been reported as highly accurate for the identification of malignancy. Mammography is therefore best used when the physical examination findings are indeterminate. Ultrasonography may be used as an adjunct to mammography; no evidence supports the use of magnetic resonance imaging in male breast patients. If clinical or mammographic features are suspicious or indeterminate for malignancy, tissue diagnosis is warranted and may be achieved surgically or via core-needle biopsy or fine-needle aspiration cytology. Given the lack of uniformity in the clinical recommendations for the evaluation of breast masses in men, a practical approach is proposed.
在评估男性乳腺肿块时必须考虑乳腺癌，尽管各种良性病因更为常见，包括男性乳房发育以及皮肤和皮下组织疾病。患者的病史可能会发现提示恶性肿瘤的关键特征或提示良性疾病的安心特征。有文献记载，体格检查在区分良性和恶性病变方面与乳房X线摄影一样有效，并且两者在识别恶性肿瘤方面均被报道具有很高的准确性。因此，当体格检查结果不明确时，乳房X线摄影是最佳选择。超声检查可作为乳房X线摄影的辅助手段；没有证据支持在男性乳腺患者中使用磁共振成像。如果临床或乳房X线摄影特征可疑或不能确定是否为恶性肿瘤，则有必要进行组织诊断，可通过手术、粗针活检或细针穿刺细胞学检查来实现。鉴于男性乳腺肿块评估的临床建议缺乏统一性，本文提出了一种实用的方法。
