American College of Radiology
ACR Appropriateness Criteria®

Evaluation of the Symptomatic Male Breast

Variant 1: Male patient of any age with symptoms of gynecomastia and physical examination consistent with gynecomastia or pseudogynecomastia. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually not appropriate Limited ☢☢ 0.1-1mSv 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (28624748) 4
13 (27101347) 3
11 (318597) 4
US breast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (28624748) 4
23 (27734795) 3
20 (26543053) 3
18 (24286092) 3
22 (23345385) 4
21 (23218476) 4
17 (20151357) 3
16 (20375373) 3
19 (24161780) 3
Digital breast tomosynthesis diagnostic Usually not appropriate Limited ☢☢ 0.1-1mSv 2 2 3 14 0 1 0 0 0 0 0
References Study Quality
15 (24852677) 4
14 (24113063) 4
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 2: Male younger than 25 years of age with indeterminate palpable breast mass. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
3 (20571799) 3
Mammography diagnostic May be appropriate Limited ☢☢ 0.1-1mSv 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
1 (16473746) 4
2 (17352365) 3
Digital breast tomosynthesis diagnostic May be appropriate Limited ☢☢ 0.1-1mSv 5 5 1 0 1 1 14 0 1 0 0
References Study Quality
26 (25086999) 2
15 (24852677) 4
14 (24113063) 4
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 3: Male 25 years of age or older with indeterminate palpable breast mass. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate Strong ☢☢ 0.1-1mSv 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (28624748) 4
29 (21343472) 4
28 (16958958) 3
6 (19020230) 4
1 (16473746) 4
2 (17352365) 3
27 (16844928) 4
9 (11425067) 2
8 (23182522) 3
Digital breast tomosynthesis diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 8 8 0 1 0 0 1 0 1 12 3
References Study Quality
26 (25086999) 2
15 (24852677) 4
14 (24113063) 4
US breast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
3 (20571799) 3
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 4: Male 25 years of age or older with indeterminate palpable breast mass. Mammography or digital breast tomosynthesis indeterminate or suspicious.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
US breast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
28 (16958958) 3
3 (20571799) 3
MRI breast without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 n/a 0 0 0 0 0 0 0 0 0
MRI breast without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
Variant 5: Male of any age with physical examination suspicious for breast cancer (suspicious palpable breast mass, axillary adenopathy, nipple discharge, or nipple retraction). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
Mammography diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (28624748) 4
28 (16958958) 3
11 (318597) 4
6 (19020230) 4
3 (20571799) 3
27 (16844928) 4
9 (11425067) 2
24 (2218826) 4
Digital breast tomosynthesis diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 9 9 0 0 0 0 0 0 1 2 15
References Study Quality
26 (25086999) 2
15 (24852677) 4
14 (24113063) 4
US breast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
12 (28624748) 4
32 (25772378) 3
31 (21745659) 4
30 (20560973) 3
28 (16958958) 3
11 (318597) 4
16 (20375373) 3
3 (20571799) 3
MRI breast without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
33 (27709811) 4
34 (16371581) 3
MRI breast without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 1 n/a 0 0 0 0 0 0 0 0 0
References Study Quality
33 (27709811) 4
34 (16371581) 3
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.