Paget's disease of the breast biopsy
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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
A full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget's disease of the breast. Findings on biopsy diagnostic of Paget's disease of the breast include presence of Paget cells, which are arranged in solid groups.
Biopsy
- The diagnosis of Paget's disease can be made from a wedge biopsy, a superficial shave biopsy of epidermis or from a punch biopsy.[1]
- Wedge biopsy is the most useful method to make the diagnosis because the biopsy is likely to include the epidermis and a part of lactiferous duct.
- It is essential that the sample contains part of the lactiferous duct and if the areola is affected, it also needs to be represented in the sample to confirm the diagnosis.[2]
- A shave biopsy is less likely to contain sufficient number of Paget's cells, especially when the surface of the lesion is ulcerated.
- A punch biopsy will include the underlying stroma and possibly part of a duct. It frequently provides less epidermis to examine.
- Many times a full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget's disease of the breast.
- This is especially in a patient with nipple–areola skin changes.[3][4]
- Biopsy is not always successful, therefore, it is at times necessary to take a second biopsy or to excise the nipple.
- Often histological exams are inconclusive and more biopsies, or even surgical removal of the entire nipple may be required.
- The main histological characteristic is the presence of Paget cells, which are arranged in solid groups.
- On occasion, they form glandular arrangements outlining the basal epidermis and exhibit migration to the granular layer, similarly to melanocytes.
To view histopathologic characteristic features of Paget's disease of the breast, click here.
References
- ↑ Gupta RK, Simpson J, Dowle C (August 1996). "The role of cytology in the diagnosis of Paget's disease of the nipple". Pathology. 28 (3): 248–50. PMID 8912355.
- ↑ Lucarotti ME, Dunn JM, Webb AJ (October 1994). "Scrape cytology in the diagnosis of Paget's disease of the breast". Cytopathology. 5 (5): 301–5. PMID 7529588.
- ↑ Lopes Filho, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M. S. S.; Michalany, Alexandre Osores; Matsunaga, Nobuo (2015). "Mammary and extramammary Paget's disease". Anais Brasileiros de Dermatologia. 90 (2): 225–231. doi:10.1590/abd1806-4841.20153189. ISSN 1806-4841.
- ↑ Rosen, Paul (2014). Rosen's breast pathology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781451176537.