Paget's disease of the breast other imaging findings

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.

• 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.
• It has limited reliability in the detection of underlying DCIS in women with Paget’s disease.^[1]
• 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%).^[2][3]
• Mammography is done bilaterally to asses the contralateral breast, for masses or clusters of microcalcifications, to exclude multifocal disease.
• Mammography should be used for follow-up visits in patients. Mammography findings of Paget’s disease of the breast include:^[4][5]
  • 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.

• 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]

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