Purpose: Optimal evaluation of male breast cancer is inadequately studied. We routinely perform axillary imaging of males with invasive breast cancer. However, despite the importance of nodal status for informing treatment and prognosis, axillary ultrasound (AUS) is not standard. We therefore aimed to assess the prevalence and prognostic value of suspicious lymphadenopathy on AUS in males with breast cancer.
Materials and Methods: After IRB approval, we identified 60 male breast cancer patients with available diagnostic imaging who underwent surgery including nodal evaluation at our institution.
Results: Final pathology revealed DCIS in 6, invasive cribriform carcinoma in 1, papillary carcinoma in 1, and IDC in 52 patients (87%). Tumor grade was 1 in 11%, 2 in 60%, and 3 in 29%. Mean tumor size was 21 mm on surgical pathology (range 3-80 mm). All tumors were ER-positive, 91% PR-positive, and 13% were Her-2-positive. Thirty of 54 patients with invasive cancer (56%) were lymph node-positive at operation. Forty-eight of 54 men with invasive cancer (89%) had AUS performed at diagnosis. Twenty-two of the 48 (46%) had suspicious findings and FNA, with 15 (68%) FNA+. Sixteen of 48 evaluated with AUS (33%) had a true negative AUS. Ten (21%) had false negative US results (node-positive at surgery). Two (4%) had negative axillary biopsies and surgical pathology after abnormal AUS. Four patients (8% of AUS, 18% of FNAs) had a false negative FNA (node-positive at surgery). One patient had a positive FNA without lymph node involvement identified at surgery. In this patient, the sampled lymph node was not removed during surgery, but given negative sentinel nodes, patient was placed on surveillance. Among FNA+ patients, 3 (20%) were treated with sentinel node surgery and 12 (80%) axillary dissection. Among FNA- patients, 6 had sentinel node surgery with 2 proceeding to axillary dissection for frozen section-positive sentinel nodes Thirty-seven underwent germline genetic testing. Pathologic mutations were found in 9 (24%): BRCA2 (5), ATM (1), CHEK2 (2), and MUTYH (1). One patient had a diagnosis of Klinefelter syndrome.
Conclusion: Fifty-six percent of the men in this series with invasive cancer had lymph node involvement at surgery. AUS correctly identified lymph node involvement in 48% at diagnosis, and 86% of men with an abnormal AUS had lymph node involvement confirmed at surgery. Therefore, AUS may help guide treatment planning for men with breast cancer.
Clinical Relevance Statement: Axillary ultrasound should be performed with breast ultrasound for evaluation of male breast cancer, but not replace surgical nodal staging.
