Breast cancer in men is rare, accounting for approximately 1 percent of all cases of breast cancer. Differentiating cancer from the many other causes of breast enlargement in men is problematic, resulting in the usual recommendation to biopsy all lesions.Vetto and colleagues conducted a diagnostic test study and cost-effectiveness analysis to assess the combination of physical examination and fine-needle aspiration in the diagnosis of breast masses in men as an alternative to routine surgical biopsy.
The authors studied 51 men referred to three breast clinics between 1991 and 1996. Each patient was examined by at least two skilled physicians and underwent fine-needle aspiration in triplicate. Mammography was performed before referral in 13 of the patients. Patients with breast masses that were assessed as benign were followed for up to 60 months (mean: 19 months). Patients with masses suspicious for cancer were referred for open surgical biopsy. In 38 patients, all tests concurred that the lesion was benign. None of these patients developed cancer during the follow-up period. In six patients, the tests concurred that the lesion was malignant, and this finding was confirmed at open biopsy. In seven patients, physical examination and fine-needle aspiration provided different assessments. All of the masses were found to be benign at open biopsy. Fine-needle aspiration was more likely than physical examination to correctly predict the results of the open biopsy.
The authors conclude that the combination of physical examination and fine-needle aspiration performed by experienced physicians is diagnostically accurate, can significantly reduce the number of open biopsies and is associated with an average decrease in patient charges of $510 per patient.