Rationale and Objectives
Gynecomastia is the benign enlargement of the male breast because of proliferation of the glandular component. To date, there is no radiological definition of gynecomastia and no quantitative evaluation of breast glandular tissues in the general male population. The aims of this study were to supply radiological-based measurements of breast glandular tissue in the general male population, to quantitatively assess the prevalence of gynecomastia according to age by decades, and to evaluate associations between gynecomastia and obesity, cirrhosis, and dialysis.
Materials and Methods
This retrospective study included 506 men who presented to the emergency department following trauma and underwent chest-abdominal computed tomography. Also included were 45 patients undergoing hemodialysis and 50 patients with cirrhosis who underwent chest computed tomography. The incidence and size of gynecomastia for all the study population were calculated.
Results
Breast tissue diameters of 22 mm, 28 mm, and 36 mm corresponded to 90th, 95th, and 97.5th cumulative percentiles of diameters in the general male population. Peaks of gynecomastia were shown in the ninth decade and in boys aged 13–14 years. Breast tissue diameter did not correlate with body mass index (r = −0.031). Patients undergoing hemodialysis and patients with cirrhosis had higher percentages ( P < .0001) of breast tissue diameters above 22 mm, 28 mm, and 36 mm.
Conclusions
Breast tissue diameter is a simple and reliable quantitative tool for the assessment of gynecomastia. This method provides the ability to determine the incidence of gynecomastia by age in the general population. Radiological gynecomastia should be defined as 22 mm, 28 mm, or 36 mm (90th, 95th, and 97.5th percentiles, respectively). Radiological gynecomastia is not associated with obesity, but is associated with cirrhosis and dialysis.
Introduction
Gynecomastia is the benign enlargement of the male breast because of proliferation of the glandular component , and is the most common abnormality in the male breast . It is caused by an imbalance between estrogen and androgen actions in breast tissue that can occur through multiple mechanisms . A trimodal age distribution has been reported for gynecomastia: during the neonatal period, puberty, and in elderly men . The prevalence of gynecomastia varies substantially between different reports, ranging from 32% to 65% . Etiologies that have been suggested as causes of gynecomastia include physiologic or idiopathic gynecomastia , medication or substance use , systemic diseases such as cirrhosis or renal failure , primary or secondary hypogonadism , hormone-producing tumors such as testicular cancer , and other causes .
Several studies addressed the presumed association between gynecomastia and obesity , but no conclusive results have been presented. In a review article published in the New England Journal of Medicine , it is stated that there is a progressive increase in the prevalence of gynecomastia with an increase of the body mass index (BMI), probably reflecting local paracrine effects of estradiol production in the subareolar fat on the breast glandular tissue .
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Methods
Get Radiology Tree app to read full this article<
Patients
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Imaging Technique
Get Radiology Tree app to read full this article<
Imaging Evaluation
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
![Figure 1, (a) A 45-year-old male trauma patient. The patient is morbidly obese (body mass index [BMI] = 37.5). Small breast tissue is seen (right = 7 mm, left = 5 mm). Notice also a fractured right rib ( arrow ). (b) A 13-year-old trauma patient. Bilateral gynecomast is seen (right = 33 mm, left = 33 mm). (c) A 53-year-old patient with hepatitis C virus (HCV)-related cirrhosis. Notice the marked gynecomastia (right = 39.5 mm, left = 43.5 mm). There is also a left pleural effusion. (d) A 79-year-old patient undergoing hemodialysis. Marked gynecomastia is demonstrated (right = 43.5 mm, left = 49.5 mm).](https://storage.googleapis.com/dl.dentistrykey.com/clinical/QuantitativeCTAssessmentofGynecomastiaintheGeneralPopulationandinDialysisCirrhoticandObesePatients/0_1s20S1076633217304865.jpg)
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Statistical Analysis
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Results
Patients
Get Radiology Tree app to read full this article<
TABLE 1
Demographic and Clinical Data in the General Male Population Group ( n = 506)
Age Range (y) Number of Patients in the Age Group N (%) Number of Patients with BMI at Admission N (%) Average BMI (±SD) Median BMI (IQR) Overall 506 (100%) 379/506 (74.0%) 26.2 (±4.3) 25.4 (23.5–28.4) 10–19 y 75/506 (14.8%) 30/75 (40.0%) 23.0 (±2.9) 23.9 (19.9–25.4) 20–29 y 68/506 (13.4%) 55/68 (80.9%) 24.4 (±3.6) 24.2 (21.6–25.7) 30–39 y 68/506 (13.4%) 55/68 (80.9%) 25.9 (±4.4) 25.1 (23.2–27.7) 40–49 y 63/506 (12.5%) 52/63 (82.5%) 27.7 (±5.6) 26.8 (23.7–30.0) 50–59 y 62/506 (12.3%) 52/62 (83.9%) 27.6 (±4.0) 27.6 (24.7–29.8) 60–69 y 59/506 (11.7%) 42/59 (71.2%) 26.9 (±3.8) 26.4 (24.5–29.9) 70–79 y 62/506 (12.6%) 54/62 (87.1%) 26.5 (±3.0) 26.5 (24.6–27.7) 80–93 y 49/506 (9.7%) 39/49 (79.6%) 26.5 (±4.4) 25.4 (23.5–30.1)
BMI, body mass index; IQR, interquartile range; SD, standard deviation.
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Imaging Evaluation
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
TABLE 2
Breast Tissue Diameters Distribution ( n = 1012)
Age Range (y) Number of Breasts, N (%) Average Breast Tissue Diameter, mm (±SD) Median Breast Tissue Diameter, mm (IQR) 90th Percentile Cutoff Value, mm 95th Percentile Cutoff Value, mm 97.5th Percentile Cutoff Value, mm Overall 1012 (100%) RA: 12.4 (±7.9) RA: 11.0 (7.0–15.0) RA: 22.0 RA: 28.0 RA: 36.0 RB: 12.2 (±7.8) RB: 10.5 (7.0–15.0) RB: 22.0 RB: 28.0 RB: 35.0 10–19 y 150/1012 (14.8%) RA: 12.6 (±8.4) RA: 11.0 (7.0–16.0) RA: 23.7 RA: 33.0 RA: 36.7 RB: 12.8 (±9.1) RB: 10.9 (7.0–16.0) RB: 22.7 RB: 35.0 RB: 38.7 20–29 y 136/1012 (13.4%) RA: 12.8 (±6.8) RA: 11.5 (8.0–17.0) RA: 21.0 RA: 25.1 RA: 28.0 RB: 13.3 (±7.2) RB: 12.5 (8.0–18.0) RB: 23.1 RB: 26.0 RB: 27.6 30–39 y 136/1012 (13.4%) RA: 12.4 (±6.8) RA: 11.0 (7.0–16.0) RA: 22.0 RA: 26.2 RA: 29.9 RB: 12.7 (±6.4) RB: 12.0 (8.0–16.0) RB: 21.0 RB: 25.2 RB: 31.9 40–49 y 126/1012 (12.5%) RA: 12.4 (±7.6) RA: 11.0 (7.0–15.0) RA: 23.3 RA: 28.9 RA: 35.8 RB: 11.4 (±7.6) RB: 10.0 (7.0–13.0) RB: 21.1 RB: 25.8 RB: 36.1 50–59 y 124/1012 (12.3%) RA: 10.5 (±7.5) RA: 9.0 (7.0–11.0) RA: 19.0 RA: 23.0 RA: 36.1 RB: 10.0 (±7.1) RB: 8.0 (6.0–12.0) RB: 18.5 RB: 24.4 RB: 32.6 60–69 y 118/1012 (11.7%) RA: 10.8 (±6.3) RA: 9.0 (6.0–14.0) RA: 19.2 RA: 24.0 RA: 26.0 RB: 11.3 (±6.1) RB: 11.0 (7.0–15.0) RB: 18.2 RB: 23.3 RB: 30.0 70–79 y 124/1012 (12.6%) RA: 11.8 (±8.5) RA: 9.0 (7.0–13.0) RA: 20.0 RA: 32.8 RA: 36.8 RB: 11.8 (±8.0) RB: 10.0 (7.0–14.0) RB: 20.0 RB: 30.0 RB: 34.8 80–93 y 98/1012 (9.7%) RA: 16.5 (±10.1) RA: 13.0 (10.0–20.0) RA: 34.3 RA: 39.1 RA: 45.0 RB: 14.8 (±10.0) RB: 11.0 (8.0–18.5) RB: 30.0 RB: 39.1 RB: 43.1
IQR, interquartile range; RA, Reader A; RB, Reader B; SD, standard deviation.
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
TABLE 3
Associations Between Obesity and Gynecomastia
Age Range (y) Number of Breasts N (%) Association Between Over-Weight (BMI ≥ 25) and Breast Tissue Diameter ≥ 28 mm ( P Value) Association Between Over-Weight (BMI ≥ 25) and Breast Tissue Diameter ≥ 36 mm ( P Value) Association Between Obesity (BMI ≥ 30) and Breast Tissue Diameter ≥ 28 mm ( P Value) Association Between Obesity (BMI ≥ 30) and Breast Tissue Diameter ≥ 36 mm ( P Value) Correlation Between BMI and Breast Tissue Diameters (r, P Value) Correlation Between Fat Tissue Diameter and Breast Tissue Diameters (r, P Value) Overall 758 (100%) 14/34 vs. 410/724; P = 0.076 9/15 vs. 415/743; P = 0.749 6/34 vs. 116/724; P = 0.801 4/15 vs. 118/743; P = 0.281 r = −0.031 r = −0.039P = 0.393P = 0.211 10–19 y 60/758 (15.8%) 0/5 vs. 16/55; P = 0.311 0/1 vs. 16/59; P = 1.0 — — r = 0.185 r = 0.259P = 0.031P = 0.006 20–29 y 110/758 (14.5%) 3/4 vs. 35/106; P = 0.118 2/2 vs. 36/108; P = 0.117 2/4 vs. 6/106; P = 0.026 2/2 vs. 6/108; P = 0.005 r = 0.032 r = 0.234P = 0.716P = 0.014 30–39 y 110/758 (14.5%) 1/1 vs. 59/109; P = 1.0 — 1/1 vs. 17/109; P = 0.164 — r = 0.009 r = −0.038P = 0.923P = 0.700 40–49 y 104/758 (13.7%) 3/5 vs. 71/99; P = 0.625 0/1 vs. 66/103; P = 0.365 0/3 vs. 26/101; P = 0.571 0/1 vs. 26/103; P = 1.0 r = 0.069 r = −0.015P = 0.444P = 0.882 50–59 y 104/758 (13.7%) 3/5 vs. 71/99; P = 0.625 2/3 vs. 72/101; P = 1.0 0/5 vs. 22/99; P = 0.582 0/3 vs. 22/101; P = 1.0 r = 0.069 r = 0.161P = 0.444P = 0.144 60–69 y 84/758 (11.1%) 2/2 vs. 54/82; P = 0.550 1/1 vs. 55/83; P = 1.0 2/2 vs. 18/82; P = 0.055 1/1 vs. 19/83; P = 0.238 r = −0.064 r = 0.161P = 0.491P = 0.144 70–79 y 108/758 (14.2%) 0/6 vs. 72/102; P = 0.001 0/1 vs. 72/107; P = 0.333 0/6 vs. 8/102; P = 1.0 0/1 vs. 8/107; P = 1.0 r = −0.173 r = −0.319P = 0.055P = 0.001 80–93 y 78/758 (10.3%) 4/8 vs. 38/70; P = 1.0 4/5 vs. 38/72; P = 0.681 1/8 vs. 19/70; P = 0.672 1/6 vs. 19/72; P = 1.0 r = −0.199 r = −0.199P = 0.081P = 0.081
BMI, body mass index.
Data in columns 3–6 are presented as: (# gynecomastia with obesity)/(# gynecomastia) versus (# without gynecomastia with obesity)/(# without gynecomastia). Data in columns 7–8 present correlations between BMI, fat tissue diameters, and breast tissue diameters. Reader A measurements are used as reference.
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Discussion
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
References
1. Braunstein G.D.: Gynecomastia. N Engl J Med 1993; 328: pp. 490-495.
2. Nguyen C., Kettler M.D., Swirsky M.E., et. al.: Male breast disease: pictorial review with radiologic-pathologic correlation. Radiographics 2013; 33: pp. 763-779.
3. Braunstein G.D.: Clinical practice. Gynecomastia. N Engl J Med 2007; 357: pp. 1229-1237.
4. Cuhaci N., Polat S.B., Evranos B., et. al.: Gynecomastia: clinical evaluation and management. Ind J Endocrinol Metab 2014; 18: pp. 150-158.
5. Niewoehner C.B., Nuttal F.Q.: Gynecomastia in a hospitalized male population. Am J Med 1984; 77: pp. 633-638.
6. Nuttall F.Q.: Gynecomastia as a physical finding in normal men. J Clin Endocrinol Metab 1979; 48: pp. 338-340.
7. Bannayan G.A., Hajdu S.I.: Gynecomastia: clinicopathologic study of 351 cases. Am J Clin Pathol 1972; 57: pp. 431-437.
8. Georgiadis E., Papandreou L., Evangelopoulou C., et. al.: Incidence of gynaecomastia in 954 young males and its relationship to somatometric parameters. Ann Hum Biol 1994; 21: pp. 579-587.
9. Dickson G.: Gynecomastia. Am Fam Physician 2012; 85: pp. 716-722.
10. Ladizinski B., Lee K.C., Nutan F.N., et. al.: Gynecomastia: etiologies, clinical presentations, diagnosis, and management. South Med J 2014; 107: pp. 44-49.
11. Rahmani S., Turton P., Shaaban A., et. al.: Overview of gynecomastia in the modern era and the Leeds Gynaecomastia Investigation algorithm. Breast J 2011; 17: pp. 246-255.
12. Yazici M., Sahin M., Bolu E., et. al.: Evaluation of breast enlargement in young males and factors associated with gynecomastia and pseudogynecomastia. Ir J Med Sci 2010; 179: pp. 575-583.
13. Bautista-Vidal C., Barnoiu O., Garcia-Galisteo E., et. al.: Treatment of gynecomastia in patients with prostate cancer and androgen deprivation. Actas Urol Esp 2014; 38: pp. 34-40.
14. Bowman J.D., Kim H., Bustamante J.J.: Drug-induced gynecomastia. Pharmacotherapy 2012; 32: pp. 1123-1140.
15. Cavanaugh J., Niewoehner C.B., Nuttall F.Q.: Gynecomastia and cirrhosis of the liver. Arch Intern Med 1990; 150: pp. 563-565.
16. Nardoni A., Marchetti E., Geatti O., et. al.: [Prolactin in chronic alcoholic liver diseases with and without gynecomastia]. Minerva Med 1985; 76: pp. 37-42.
17. Caron P., Dueymes J.M., Pourrat J., et. al.: [Gynecomastia and chronic renal insufficiency in periodic hemodialysis. Demonstration of a decrease in the free fraction of testosterone]. Rev Med Interne 1984; 5: pp. 110-113.
18. Cavalca A., Tortelli O., Zanini P., et. al.: [Gynecomastia in chronic renal insufficiency. Presentation of a clinical case]. Minerva Urol Nefrol 1995; 47: pp. 85-88.
19. Nieschlag E.: Klinefelter syndrome: the commonest form of hypogonadism, but often overlooked or untreated. Dtsch Arztebl Int 2013; 110: pp. 347-353.
20. Salenave S., Trabado S., Maione L., et. al.: Male acquired hypogonadotropic hypogonadism: diagnosis and treatment. Ann Endocrinol (Paris) 2012; 73: pp. 141-146.
21. Kolitsas N., Tsambalas S., Dimitriadis F., et. al.: Gynecomastia as a first clinical sign of nonseminomatous germ cell tumor. Urol Int 2011; 87: pp. 248-250.
22. Hassan H.C., Cullen I.M., Casey R.G., et. al.: Gynaecomastia: an endocrine manifestation of testicular cancer. Andrologia 2008; 40: pp. 152-157.
23. Klang E., Rozendorn N., Raskin S., et. al.: CT measurement of breast glandular tissue and its association with testicular cancer. Eur Radiol 2017; 27: pp. 536-542.
24. Rosen H., Webb M.L., DiVasta A.D., et. al.: Adolescent gynecomastia: not only an obesity issue. Ann Plast Surg 2010; 64: pp. 688-690.
25. Mainiero M.B., Lourenco A.P., Barke L.D., et. al.: ACR appropriateness criteria evaluation of the symptomatic male breast. J Am College Radiol 2015; 12: pp. 678-682.
26. Chen P.H., Slanetz P.J.: Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia. Eur J Radiol 2014; 83: pp. 123-129.
27. Athwal R.K., Donovan R., Mirza M.: Clinical examination allied to ultrasonography in the assessment of new onset gynaecomastia: an observational study. J Clin Diagn Res 2014; 8: pp. Nc9-Nc11.
28. Lapid O., Siebenga P., Zonderland H.M.: Overuse of imaging the male breast-findings in 557 patients. Breast J 2015; 21: pp. 219-223.
29. Tangerud A., Potapenko I., Skjerven H.K., et. al.: Radiologic evaluation of lumps in the male breast. Acta Radiol 2016; 57: pp. 809-814.
30. Sonnenblick E.B., Salvatore M., Szabo J., et. al.: Incremental role of mammography in the evaluation of gynecomastia in men who have undergone chest CT. AJR Am J Roentgenol 2016; pp. 1-7.
31. Ng M., Fleming T., Robinson M., et. al.: Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: pp. 766-781.
32. Kim J., Lim H., Lee S.I., et. al.: Thickness of rectus abdominis muscle and abdominal subcutaneous fat tissue in adult women: correlation with age, pregnancy, laparotomy, and body mass index. Arch Plast Surg 2012; 39: pp. 528-533.
33. Yunhai W., Wei C., Jian Z., et. al.: Efficient volume exploration using the Gaussian mixture model. IEEE Trans Vis Comput Graph 2011; 17: pp. 1560-1573.
34. Niewoehner C.B., Schorer A.E.: Gynaecomastia and breast cancer in men. BMJ 2008; 336: pp. 709-713.
35. Lemaine V., Cayci C., Simmons P.S., et. al.: Gynecomastia in adolescent males. Semin Plast Surg 2013; 27: pp. 56-61.
36. Johnson R.E., Murad M.H.: Gynecomastia: pathophysiology, evaluation, and management. Mayo Clin Proc 2009; 84: pp. 1010-1015.
37. Kumanov P., Deepinder F., Robeva R., et. al.: Relationship of adolescent gynecomastia with varicocele and somatometric parameters: a cross-sectional study in 6200 healthy boys. J Adolesc Health 2007; 41: pp. 126-131.