Mammography and Ultrasonography for Symptomatic Male Breast Lesions: A PRISMA-DTA Systematic Review and Meta-analysis.
Abstract
Rationale
AND
Objectives
Male breast disease is uncommon, but symptomatic men require reliable differentiation between benign conditions and lesions warranting biopsy or oncologic management. This PRISMA-DTA (Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies) systematic review and meta-analysis evaluated the diagnostic accuracy, clinical utility, and evidentiary limitations of mammography and ultrasonography for malignant versus benign male breast lesions.
Materials And Methods
PubMed, Embase, Web of Science Core Collection, and Scopus were searched from inception to May 30, 2026. The protocol was registered in PROSPERO before journal submission (CRD420261429183). Eligible reports evaluated mammography or ultrasonography in male breast disease and provided extractable 2 × 2 diagnostic data. Methodological quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. Diagnostic accuracy was synthesized separately for each modality using bivariate random-effects modeling and summary receiver operating characteristic analysis.
Results
Thirteen eligible reports were included. Seven mammography datasets and five ultrasonography datasets were available for quantitative synthesis. Mammography showed a pooled sensitivity of 0.840 (95% confidence interval [CI], 0.705-0.921) and a specificity of 0.951 (95% CI, 0.884-0.980), whereas ultrasonography showed a pooled sensitivity of 0.881 (95% CI, 0.775-0.941) and a specificity of 0.958 (95% CI, 0.869-0.987). Although pooled specificity estimates were high, their magnitude may have been influenced by heterogeneous diagnostic thresholds, differential verification, variable follow-up, and sparse malignant case counts. Nine of 13 reports were judged to have an overall high risk of bias, and consistent paired head-to-head data were lacking.
Conclusion
Current evidence supports mammography and ultrasonography as complementary tools in risk-stratified assessment of symptomatic male breast lesions. Pooled estimates should be interpreted cautiously because the evidence base is small and methodologically limited. Current data do not establish direct modality superiority, do not justify biopsy avoidance when clinical-imaging discordance persists, and do not determine the incremental value of routine combined imaging.