Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Endocrinology, Athens Naval and Veteran Affairs Hospital, Athens, Greece.
Andrology. 2021 Sep;9(5):1444-1456. doi: 10.1111/andr.13051. Epub 2021 Jun 10.
Gynecomastia (GM) is the benign proliferation of glandular tissue in the male breast. It is a common condition, which may occur physiologically and shows three age peaks during a male's lifespan: infancy, puberty, and senescence. An underlying pathology may be revealed in 45%-50% of adult men with GM, such as aggravating medications, systemic diseases, obesity, endocrinopathies, or malignancy.
To discuss the role of imaging in the evaluation of GM and its contribution to therapeutic decision-making.
MATERIALS/METHODS: The current literature was reviewed through PubMed, Scopus, and CENTRAL electronic databases to identify the best available evidence concerning imaging modalities in patients with GM.
Most male breast lesions can be diagnosed on clinical grounds; however, in certain cases, when physical examination is inconclusive, imaging may be helpful.
The main purpose of evaluating a patient with GM is to establish the diagnosis and differentiate true GM from pseudogynecomastia, exclude breast cancer, and detect the possible cause. GM is seen in mammography as a subareolar opacity and three mammographic patterns of GM are described: nodular, dendritic, and diffuse, corresponding to florid GM of early onset, fibrous persistent GM, and GM due to exogenous estrogen administration, respectively. In ultrasound (US), florid GM is depicted as a disk-shaped, hypoechoic area underlying the areola, whereas echogenicity of the lesions increases as fibrosis develops. Data on the use of MRI in the evaluation of the male breast and GM are still limited. Imaging findings can be classified according to the BIRADS (breast imaging reporting and data system) based on their malignant potential.
Both mammography and US are sensitive and specific to diagnose GM and distinguish it from breast cancer. When clinical findings are suggestive of malignancy or imaging findings are inconclusive, a histological confirmation should be sought.
男性乳房发育症（GM）是男性乳房中腺体组织的良性增生。它是一种常见的疾病，可能在生理上发生，并在男性的一生中表现出三个年龄高峰：婴儿期、青春期和老年期。45%-50%的成年男性 GM 可能存在潜在的病理学，如加重的药物、系统性疾病、肥胖、内分泌疾病或恶性肿瘤。
讨论影像学在 GM 评估中的作用及其对治疗决策的贡献。
材料/方法：通过 PubMed、Scopus 和 CENTRAL 电子数据库对当前文献进行综述，以确定有关 GM 患者影像学方式的最佳可用证据。
大多数男性乳房病变可以通过临床依据进行诊断；然而，在某些情况下，当体格检查不确定时，影像学可能会有所帮助。
评估 GM 患者的主要目的是确定诊断并区分真正的 GM 与假性男性乳房发育症，排除乳腺癌，并发现可能的病因。GM 在乳房 X 线摄影中表现为乳晕下的局灶性不透光影，GM 有三种乳房 X 线摄影模式：结节状、树突状和弥漫性，分别对应于早期发病的明显 GM、纤维性持续性 GM 和由于外源性雌激素治疗引起的 GM。在超声（US）中，明显 GM 表现为乳晕下的盘状、低回声区域，而随着纤维化的发展，病变的回声强度增加。关于 MRI 在男性乳房和 GM 评估中的应用的数据仍然有限。根据其恶性潜能，可根据 BIRADS（乳房成像报告和数据系统）对成像结果进行分类。
乳房 X 线摄影和 US 对 GM 的诊断均具有敏感性和特异性，并可将其与乳腺癌区分开来。当临床发现提示恶性肿瘤或影像学发现不确定时，应寻求组织学证实。
