An audit of the spectrum of male breast pathology imaged at CMJAH Breast Imaging Department
Date
2020
Authors
Murfin, Tarryn-Lee
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Abstract
Background:
Breast pathology awareness is generally a characteristic of the female population due to
greater incidence of malignant disease and the implications of morbidity and mortality.
Male breast pathology receives less attention, although referrals of men to Breast Imaging
units are increasing. In lower-middle income countries such as South Africa, a higher rate
of HIV disease and growing number of men receiving HAART, an identifiable risk factor
for male breast disease, is present. Clinical, mammographic and ultrasonographic review of
male breast disease is of increasing importance, to assess both hospital prevalence and
spectrum of disease.
Objectives:
The primary objective is to evaluate both the prevalence and spectrum of male breast
disease referred to a tertiary Breast Imaging Unit. The secondary objective is to identify
aetiological risk factors for different male breast diseases .
Methods: This is a descriptive retrospective cross sectional audit of males presenting to the Breast
imaging unit at Charlotte Maxeke Johannesburg Academic Hospital, South Africa, over the
3 year period (1st January 2016 to 31st December 2018). Both Imaging, histology, MC&S
and serology were documented for retrospective statistical analysis.
Results:
The study group consisted of 261 of which the mean age was 46 years (range 13 -83).
Benign breast disease with gynaecomastia predominating (85.44%), infectious diseases
(2.29%) and miscellaneous group of benign disease (5.37%).
Malignant disease of the breast (5.3%) or adjacent tissue (1.4%) accounted for a total of
6.9% of cases. Male breast cancer has similar histopathology and molecular subtype in
comparison to Female breast cancer in recent reports.
In young and middle age South African men, gynaecomastia is most frequently associated
with HIV where in this study 35% of the patients were seropositive. Further investigation
of viral load and CD4 counts were infrequently performed. In the elderly men with
gynaecomastia, obesity, diabetes and liver disease were not infrequent co-morbidities.
However, liver function and endocrine tests were rarely done. Scrotal ultrasonography is
mandatory in adolescent boys to exclude both oestrogen-producing tumours and
varicoceles.
Conclusions:
In this retrospective audit of 261 men referred to a tertiary Breast Imaging Unit, there was
a wide spectrum of benign and malignant disease. However, the finding that 5.4% of men
had male breast cancer was unexpected. This highlights the importance of histological
biopsy of any radiologically suspicious pathology.
The 34,87% (91/261) HIV seropositive subgroup of male patients displayed similar
spectrum and distribution of both benign and malignant male breast disease, as that of their
HIV seronegative and non-tested majority within this study group. Consistent HIV
serological testing is required as the patients did not reflect that they originate from a high
HIV positive referral population group. This would allow for both HIV seropositivity and
HAART regimes effects on male breast disease to be better evaluated and concluded upon.
This review audit highlights the necessity for multidisciplinary team follow-up and audits,
as a critical part of approach and management of both benign and malignant male breast
disease. It’s imperative that patients are counseled to highlight the importance of their
diagnosis, implications of treatment and the need to attend follow-up appointments. Where
short falls are noted, a reviewed protocol orientated towards better approach and
management plans is required to maximize the efficacy of a multidisciplinary team in
Clinical Male breast disease overall.
Description
A research submitted in fulfilment for the degree of Masters of Medicine in Diagnostic Radiology to the Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, 2020
Keywords
Male Breast Pathology