372 Imaging in Gynaecomastia: Audit of Imaging Practice at BHRUT to Establish Guidelines

Aim Our study aim was to audit our imaging practice against national standards to formulate guidelines and standardise practice. Method The authors performed a retrospective data collection of imaging and pathology for clinically suspected gynaecomastia in our breast unit between January and December 2023, using hospital radiology and pathology computer information systems. Data included clinical history, clinical, ultrasound and mammographic scores. Patients with clinical suspicion of malignancy (written on imaging request or P4/P5) were excluded. Descriptive statistics were performed. Results A total of 148 male patients had been referred for imaging with P1 (19), P2 (113), P3 (11) or no P value (34), clinical history stating or querying gynaecomastia. Ultrasound was performed in all patients. All P1 and P2 patients were U1 or U2, and M1 or M2 if mammogram was performed (0/19 P1 patients, 20/113 P2 patients, 4/11 P3 patients). In P1, P2 and no P value patients, 6/166 patients underwent ultrasound-guided biopsy (5/6 B2 gynaecomastia, 1/6 B1 benign angiolipoma). In P3 patients, two biopsies were performed: B2 gynaecomastia in one patient, but one biopsy (M4U4) revealed B5b invasive carcinoma. Conclusions The findings support guideline formulation where imaging is not indicated for typical (P1, P2) gynaecomastia. Imaging should, however, be performed where there is any doubt at all about the clinical diagnosis. The probability of finding cancer when performing imaging of clinically benign findings in the male breast is negligible. Routine imaging of gynecomastia should be discouraged.