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
11 (318597) 4
13 (27101347) 3
12 (28624748) 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
19 (24161780) 3
16 (20375373) 3
17 (20151357) 3
21 (23218476) 4
22 (23345385) 4
18 (24286092) 3
20 (26543053) 3
23 (27734795) 3
12 (28624748) 4
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
14 (24113063) 4
15 (24852677) 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
2 (17352365) 3
1 (16473746) 4
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
14 (24113063) 4
15 (24852677) 4
26 (25086999) 2
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
8 (23182522) 3
9 (11425067) 2
27 (16844928) 4
2 (17352365) 3
1 (16473746) 4
6 (19020230) 4
28 (16958958) 3
29 (21343472) 4
12 (28624748) 4
Digital breast tomosynthesis diagnostic Usually appropriate Limited ☢☢ 0.1-1mSv 8 8 0 1 0 0 1 0 1 12 3
References Study Quality
14 (24113063) 4
15 (24852677) 4
26 (25086999) 2
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
3 (20571799) 3
28 (16958958) 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
24 (2218826) 4
9 (11425067) 2
27 (16844928) 4
3 (20571799) 3
6 (19020230) 4
11 (318597) 4
28 (16958958) 3
12 (28624748) 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
14 (24113063) 4
15 (24852677) 4
26 (25086999) 2
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
16 (20375373) 3
11 (318597) 4
28 (16958958) 3
30 (20560973) 3
31 (21745659) 4
32 (25772378) 3
12 (28624748) 4
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
34 (16371581) 3
33 (27709811) 4
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
34 (16371581) 3
33 (27709811) 4
Please refer to the supporting documentation for a more complete discussion of the concepts and their definitions below.
Final Tabulations:
A histogram of the number of panel members who rated the recommendation as noted in the column heading (ie, 1, 2, 3, …etc.)
Disagree:
The variation of the individual ratings from the median rating indicates panel disagreement on the final recommendation.
References:
Lists the references associated with the recommendation
SQ:
Study Quality (1, 2, 3, 4, Good M or Inadequate M) of the references listed.
RRL:
Information on the Relative Radiation Level (RRL) designations can be found here.