Paget's disease of the breast surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
Surgery is the mainstay treatment for Paget's disease of the breast. | Surgery is the mainstay treatment for Paget's disease of the breast.The indication for surgery depends on:<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> | ||
*Presence of palpable breast mass. | *Presence of palpable breast mass. | ||
*Stage, clinical, radiological and histopathological features of the underlying breast cancer. | *Stage, clinical, radiological and histopathological features of the underlying breast cancer. | ||
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{{Family tree | | | | B01 | | | | | | | | | | | | | | | B02 | | | | | | | |B01=Nipple or areola changes without palpable breast mass or mammographic abnormality|B02= Nipple or areola changes with palpable breast mass or mammographic abnormality}} | {{Family tree | | | | B01 | | | | | | | | | | | | | | | B02 | | | | | | | |B01=Nipple or areola changes without palpable breast mass or mammographic abnormality|B02= Nipple or areola changes with palpable breast mass or mammographic abnormality}} | ||
{{Family tree | |,|-|-|^|-|-|.| | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | |}} | {{Family tree | |,|-|-|^|-|-|.| | | | | | | | | | |,|-|-|-|^|-|-|-|.| | | |}} | ||
{{Family tree | C01 | | | | C02 | | | | | | | | | C03 | | | | | | C04 | | |C01=Nipple-areolar complex lesion with no ductal cancer|C02=Nipple-areolar complex lesion with [[DICS]]|C03=Invasive breast carcinoma with negative lymph node metastasis|C04=Invasive breast carcinoma with lymph node metastasis] }} | {{Family tree | C01 | | | | C02 | | | | | | | | | C03 | | | | | | C04 | | |C01=Nipple-areolar complex lesion with no ductal cancer on biopsy|C02=Nipple-areolar complex lesion with [[DICS]]|C03=Invasive breast carcinoma with negative lymph node metastasis|C04=Invasive breast carcinoma with lymph node metastasis] }} | ||
{{Family tree | |!| | | | | |!| | | | | | | | | | |!| | | | | | | |!| | | |}} | {{Family tree | |!| | | | | |!| | | | | | | | | | |!| | | | | | | |!| | | |}} | ||
{{Family tree | D01 | | | | D02 | | | | | | | | | D03 | | | | | | D04 | | | D01=Cone excision of Paget’s lesion | {{Family tree | D01 | | | | D02 | | | | | | | | | D03 | | | | | | D04 | | | D01=Cone excision of Paget’s lesion follow-up Re-biopsy if not healing |D02= Breast-conserving surgery or mastectomy with sentinel node staging with or without breast reconstruction|D03=Mastectomy with sentinel node staging with or without breast reconstruction and adjuvent therapy|D04=Radical Mastectomy with sentinel node staging and adjuvent therapy with or without breast reconstruction|}} | ||
{{Family tree/end}} | {{Family tree/end}} | ||
===Nipple or areola changes without palpable breast mass or mammographic abnormality=== | |||
*[[Mastectomy]] is considered as the standard therapy for Paget's disease of the breast. | |||
*However, breast-conserving surgery that includes removal of the [[nipple]] [[areola]] complex and lumpectomy, followed by whole-breast or moderate-dose [[radiation therapy]] to eradicate micro-invasion, is a safe option for people with Paget's disease of the breast who do not have a palpable lump in their breast and whose mammograms do not reveal a tumor. | |||
*Paget’s disease associated with [[ductal carcinoma in situ]] and invasive [[breast cancer]] treatment should include complete resection of the underlying disease with excision of the nipple-areola complex and [[radiation therapy]] of the remaining breast tissue. | *Paget’s disease associated with [[ductal carcinoma in situ]] and invasive [[breast cancer]] treatment should include complete resection of the underlying disease with excision of the nipple-areola complex and [[radiation therapy]] of the remaining breast tissue. | ||
*People with Paget's disease of the breast who have a breast tumor and are having a mastectomy should be offered sentinel lymph node [[biopsy]] to see whether the cancer has spread to the axillary [[lymph nodes]]. | *People with Paget's disease of the breast who have a breast tumor and are having a mastectomy should be offered sentinel lymph node [[biopsy]] to see whether the cancer has spread to the axillary [[lymph nodes]]. | ||
*If cancer cells are found in the sentinel lymph node(s), more extensive [[axillary lymph node]] surgery may be needed. | *If cancer cells are found in the sentinel lymph node(s), more extensive [[axillary lymph node]] surgery may be needed. | ||
* | |||
==References== | ==References== | ||
Revision as of 18:38, 17 February 2019
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Paget's disease of the breast Microchapters |
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Differentiating Paget's disease of the breast from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Paget's disease of the breast surgery On the Web |
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American Roentgen Ray Society Images of Paget's disease of the breast surgery |
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Directions to Hospitals Treating Paget's disease of the breast |
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Risk calculators and risk factors for Paget's disease of the breast surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Suveenkrishna Pothuru, M.B,B.S. [2]
Overview
Mastectomy is the mainstay of treatment for Paget's disease of the breast. Patients who do not have a palpable lump are treated with removal of the nipple and areola, followed by whole-breast radiation therapy, whereas patients with associated ductal carcinoma in situ or invasive breast cancer are treated with complete resection of the underlying disease with excision of the nipple-areola complex and radiation therapy of the remaining breast tissue. When lymph nodes are involved, more extensive axillary lymph node surgery may be needed.
Surgery
Surgery is the mainstay treatment for Paget's disease of the breast.The indication for surgery depends on:[1]
- Presence of palpable breast mass.
- Stage, clinical, radiological and histopathological features of the underlying breast cancer.
- Metastatic involvement of lymph nodes.
| Treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Nipple or areola changes without palpable breast mass or mammographic abnormality | Nipple or areola changes with palpable breast mass or mammographic abnormality | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Nipple-areolar complex lesion with no ductal cancer on biopsy | Nipple-areolar complex lesion with DICS | Invasive breast carcinoma with negative lymph node metastasis | Invasive breast carcinoma with lymph node metastasis] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cone excision of Paget’s lesion follow-up Re-biopsy if not healing | Breast-conserving surgery or mastectomy with sentinel node staging with or without breast reconstruction | Mastectomy with sentinel node staging with or without breast reconstruction and adjuvent therapy | Radical Mastectomy with sentinel node staging and adjuvent therapy with or without breast reconstruction | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Nipple or areola changes without palpable breast mass or mammographic abnormality
- Mastectomy is considered as the standard therapy for Paget's disease of the breast.
- However, breast-conserving surgery that includes removal of the nipple areola complex and lumpectomy, followed by whole-breast or moderate-dose radiation therapy to eradicate micro-invasion, is a safe option for people with Paget's disease of the breast who do not have a palpable lump in their breast and whose mammograms do not reveal a tumor.
- Paget’s disease associated with ductal carcinoma in situ and invasive breast cancer treatment should include complete resection of the underlying disease with excision of the nipple-areola complex and radiation therapy of the remaining breast tissue.
- People with Paget's disease of the breast who have a breast tumor and are having a mastectomy should be offered sentinel lymph node biopsy to see whether the cancer has spread to the axillary lymph nodes.
- If cancer cells are found in the sentinel lymph node(s), more extensive axillary lymph node surgery may be needed.
References
- ↑ 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.