Paget's disease of the breast other imaging findings: Difference between revisions

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{{Paget's disease of the breast}}
{{Paget's disease of the breast}}
{{CMG}}
{{CMG}};{{AE}} {{Preeti}}
==Overview==
==Overview==
[[Mammogram]] may be performed to detect the [[breast cancer]] associated with Paget's disease of the breast, but is not always a reliable procedure for detecting it as it has limited reliability in the detection of underlying [[DCIS]] in people with this [[disease]].
==Other Imaging Findings==
==Other Imaging Findings==
===Mammogram===
===Mammogram===
In clinical suspicion of Paget's disease of the breast, mammography can help to detect the underlying malignancy. Mammography findings include:<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref>
*In clinical suspicion of Paget's disease of the breast, [[mammography]] can help to detect the underlying [[malignancy]], but is not always a reliable [[procedure]] for detecting Paget's disease of the breast.
*Skin thickening
*It has limited reliability in the detection of underlying [[DCIS]] in women with Paget's disease.<ref name="pmid8396786">{{cite journal |vauthors=Ikeda DM, Helvie MA, Frank TS, Chapel KL, Andersson IT |title=Paget disease of the nipple: radiologic-pathologic correlation |journal=Radiology |volume=189 |issue=1 |pages=89–94 |date=October 1993 |pmid=8396786 |doi=10.1148/radiology.189.1.8396786 |url=}}</ref>
*Malignant [[calcification]]
*The sensitivity of [[mammography]] is said to be significantly higher in the presence of a palpable mass(97%), as opposed to disease confined to the nipple in the absence of a palpable mass (50%).<ref name="pmid8143409">{{cite journal |vauthors=Sawyer RH, Asbury DL |title=Mammographic appearances in Paget's disease of the breast |journal=Clin Radiol |volume=49 |issue=3 |pages=185–8 |date=March 1994 |pmid=8143409 |doi= |url=}}</ref><ref name="pmid8549045">{{cite journal |vauthors=Ceccherini AF, Evans AJ, Pinder SE, Wilson AR, Ellis IO, Yeoman LJ |title=Is ipsilateral mammography worthwhile in Paget's disease of the breast? |journal=Clin Radiol |volume=51 |issue=1 |pages=35–8 |date=January 1996 |pmid=8549045 |doi= |url=}}</ref>
*Masses at the level of the nipple
*[[Mammography]] is done  bilaterally to asses the contralateral [[breast]], for [[Mass|masses]] or clusters of microcalcifications, to exclude multifocal [[disease]].
*Architectural distortion
*[[Mammography]] should be used for follow-up visits in patients. [[Mammography]] findings of Paget's disease of the breast include:<ref name="GaspariRicci2013">{{cite journal|last1=Gaspari|first1=Eleonora|last2=Ricci|first2=Aurora|last3=Liberto|first3=Valeria|last4=Scarano|first4=Angela Lia|last5=Fornari|first5=Maria|last6=Simonetti|first6=Giovanni|title=An Unusual Case of Mammary Paget’s Disease Diagnosed Using Dynamic Contrast-Enhanced MRI|journal=Case Reports in Radiology|volume=2013|year=2013|pages=1–5|issn=2090-6862|doi=10.1155/2013/206235}}</ref><ref name="pmid16887314">{{cite journal |vauthors=Günhan-Bilgen I, Oktay A |title=Paget's disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases |journal=Eur J Radiol |volume=60 |issue=2 |pages=256–63 |date=November 2006 |pmid=16887314 |doi=10.1016/j.ejrad.2006.06.010 |url=}}</ref>
*Nipple retraction
**[[Skin]] thickening
**[[Malignant]] [[calcification]]
**[[Masses]] at the level of the [[nipple]]
**Architectural distortion
**[[Nipple]] retraction
*However, literature reports that [[mammography]] finding can be negative in 22%–50% of patients. As underlying [[carcinoma]] is common even in [[women]] with a [[benign]] [[mammogram]] and no palpable [[mass]], the [[breast]] [[ultrasound]] and [[MRI]] may be useful in detecting the [[lesion]]. [[Ultrasound]] can be considered a part of initial evaluation and helpful for increasing [[sensitivity]] of [[mammography]].
 
===99mTc MIBI prone scinti-mammography===


However, the literature reports that the mammography can be negative in 22%–50% of patients. As underlying carcinoma is common even in women with a benign mammogram and no palpable mass, the breast ultrasound and MRI may be useful in detecting the lesion. Ultrasound can be considered a part of initial evaluation and helpful for increasing sensitivity of mammography.
*Intraductal proliferative Paget cells are shown to have a strong and characteristic [[99mTc MIBI]] uptake.
*This is said to be due to the proliferation, [[tumor]] growth and the [[oncogene]] overexpression of Paget’s cells.<ref name="pmid23644845">{{cite journal |vauthors=Ribeiro MP, Souza SA, Lopes FP, Rosado-de-Castro PH, Fonseca LM, Gutfilen B |title=99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer |journal=Clinics (Sao Paulo) |volume=68 |issue=3 |pages=283–9 |date=2013 |pmid=23644845 |pmc=3611895 |doi= |url=}}</ref>
*Literature correlating Paget's disease of he breast with this technique is limited.<ref name="ScopinaroMezi1998">{{cite journal|last1=Scopinaro|first1=F|last2=Mezi|first2=S|last3=Ierardi|first3=M|last4=De Vincentis|first4=G|last5=Tiberio|first5=N S|last6=David|first6=V|last7=Maggi|first7=S|last8=Sallusti|first8=E|last9=Modesti|first9=M|title=99mTc MIBI prone scintimammography in patients with suspicious breast cancer: relationship with mammography and tumor size.|journal=International Journal of Oncology|year=1998|issn=1019-6439|doi=10.3892/ijo.12.3.661}}</ref>


==References==
==References==
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[[Category:Patient information]]
[[Category:Patient information]]
[[Category:Mature chapter]]
[[Category:Mature chapter]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gynecology]]
[[Category:Surgery]]

Latest revision as of 15:48, 27 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]

Overview

Mammogram may be performed to detect the breast cancer associated with Paget's disease of the breast, but is not always a reliable procedure for detecting it as it has limited reliability in the detection of underlying DCIS in people with this disease.

Other Imaging Findings

Mammogram

99mTc MIBI prone scinti-mammography

  • Intraductal proliferative Paget cells are shown to have a strong and characteristic 99mTc MIBI uptake.
  • This is said to be due to the proliferation, tumor growth and the oncogene overexpression of Paget’s cells.[6]
  • Literature correlating Paget's disease of he breast with this technique is limited.[7]

References

  1. Ikeda DM, Helvie MA, Frank TS, Chapel KL, Andersson IT (October 1993). "Paget disease of the nipple: radiologic-pathologic correlation". Radiology. 189 (1): 89–94. doi:10.1148/radiology.189.1.8396786. PMID 8396786.
  2. Sawyer RH, Asbury DL (March 1994). "Mammographic appearances in Paget's disease of the breast". Clin Radiol. 49 (3): 185–8. PMID 8143409.
  3. Ceccherini AF, Evans AJ, Pinder SE, Wilson AR, Ellis IO, Yeoman LJ (January 1996). "Is ipsilateral mammography worthwhile in Paget's disease of the breast?". Clin Radiol. 51 (1): 35–8. PMID 8549045.
  4. Gaspari, Eleonora; Ricci, Aurora; Liberto, Valeria; Scarano, Angela Lia; Fornari, Maria; Simonetti, Giovanni (2013). "An Unusual Case of Mammary Paget's Disease Diagnosed Using Dynamic Contrast-Enhanced MRI". Case Reports in Radiology. 2013: 1–5. doi:10.1155/2013/206235. ISSN 2090-6862.
  5. Günhan-Bilgen I, Oktay A (November 2006). "Paget's disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases". Eur J Radiol. 60 (2): 256–63. doi:10.1016/j.ejrad.2006.06.010. PMID 16887314.
  6. Ribeiro MP, Souza SA, Lopes FP, Rosado-de-Castro PH, Fonseca LM, Gutfilen B (2013). "99mTc-thymine scintigraphy may be a promising method in the diagnosis of breast cancer". Clinics (Sao Paulo). 68 (3): 283–9. PMC 3611895. PMID 23644845.
  7. Scopinaro, F; Mezi, S; Ierardi, M; De Vincentis, G; Tiberio, N S; David, V; Maggi, S; Sallusti, E; Modesti, M (1998). "99mTc MIBI prone scintimammography in patients with suspicious breast cancer: relationship with mammography and tumor size". International Journal of Oncology. doi:10.3892/ijo.12.3.661. ISSN 1019-6439.

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