The role of sentinel lymph node biopsy in Paget's disease of the breast
ABSTRACT Sentinel lymph node (SLN) biopsy has become a standard of care for axillary lymph node staging in breast cancer and appears suitable for virtually all patients with clinically node-negative (cN0) invasive disease. However, its role in Paget's disease of the breast, a condition in which invasion may or may not be present, remains undefined.
Among 7,083 consecutive SLN biopsy procedures, we retrospectively identified 39 patients with Paget's disease of the breast. Nineteen patients had no associated clinical/radiographic features ("Paget's only"), and 20 patients had associated clinical/radiographic findings ("Paget's with findings").
The mean ages for the Paget's alone and with findings groups were 63.6 and 49.6 years, respectively. The use of breast conservation therapy was 32% in the Paget's alone group and 10% in the Paget's with findings group. Invasive carcinoma was found in 27% of patients in the Paget's alone group and 55% of patients in the Paget's with findings group. The success rate of SLN biopsy was 98%, and the mean number of SLNs removed was 3 in both groups. In the entire cohort of Paget's disease, 28% (11/39) of the patients had positive SLNs (11%, Paget's alone; 45%, Paget's with findings).
In our "Paget's only" cohort, invasive cancer was found in 27% of cases and positive SLNs in 11%. SLN biopsy should be considered in all patients with Paget's disease of the breast, whether associated clinical/radiographic findings are present.
Article: Enfermedad de Paget[Show abstract] [Hide abstract]
ABSTRACT: La enfermedad de Paget es un adenocarcinoma intraepidérmico que afecta principalmente al pezón y más raramente a otras zonas apocrinas extramamarias (anogenitales, axilares). Las enfermedades de Paget mamaria (EPM) y extramamaria (EPEM) tienen similitudes clínicas e histológicas, pero se distinguen por la frecuencia con que se asocian a un cáncer, su pronóstico y su tratamiento. La EPM se asocia de manera casi constante a un cáncer de mama. Hay que efectuar, por tanto, una mamografía, una ecografía e incluso una resonancia magnética (RM) mamaria. Respecto a la EPEM, se distinguen dos tipos: la EPEM primaria, sin otro cáncer asociado, y la EPEM secundaria, asociada a un cáncer (la mayoría de las veces ginecológico, urinario, digestivo o mamario). En caso de enfermedad de Paget secundaria, el pronóstico depende del cáncer asociado. En caso de EPEM primaria, el pronóstico es bueno, pero se altera en caso de invasión dérmica debido a los riesgos de metástasis. El tratamiento se basa principalmente en la cirugía pero, debido a la superficie a menudo extensa de las lesiones y de las recidivas frecuentes, pueden considerarse otros tratamientos (fototerapia dinámica, radioterapia, imiquimod).09/2012; 46(3):1–9. DOI:10.1016/S1761-2896(12)62719-8
Article: Paget’s disease of the nipple[Show abstract] [Hide abstract]
ABSTRACT: Paget's disease of the breast is a disorder of the nipple-areola complex that, while rare, is often associated with an underlying carcinoma. It is characterized by eczematoid changes of the nipple. Two theories have been proposed to explain the pathogenesis of Paget's disease. The Epidermotropic, which is the most accepted theory, suggests that Paget's cells originate from ductal cancer cells that had migrated from the underlying breast parenchyma. It is supported by the predominance of breast cancer markers found in Paget's disease. This article provides an overview of Paget's disease of the breast with special attention to immunohistochemistry and raises the question of new therapeutic approaches.Breast Cancer Research and Treatment 08/2013; 141(1). DOI:10.1007/s10549-013-2661-4 · 4.20 Impact Factor
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ABSTRACT: Mammary Paget's disease is a rare form of breast neoplasm that often presents with a pruritic eczema-like rash involving the nipple-areolar complex, and is refractory to common remedies. It is often associated with underlying breast cancer, and is sometimes difficult to diagnose. In this review, we present an update of the approach to Paget's disease and its surgical treatment.08/2013; 2(3). DOI:10.3978/j.issn.2227-684X.2013.08.03