Paget's Disease of the Nipple/Breast


Written by : Dr.Kishore Kumar Das, MD

Paget's disease is often confused with eczema or dermatitis, especially in its initial stages. The signs and symptoms are similar and cannot be differentiated clinically.

One important point to be noted is that Paget's disease usually starts from the nipple and spreads to the areola. But the rash in eczema or dermatitis often starts in the areola and then spreads to the nipple.

  • Breast Examination: A thorough examination of the itchy rash on the nipple may help diagnose a lump under the rash or the areola.

  • Breast Biopsy: The definitive diagnosis of Paget's disease of the breast is by biopsy of the skin. The presence of Paget's cells in the skin when examined under a microscope in a lab is confirmatory of the condition.

    A nipple biopsy allows doctors to correctly diagnose Paget disease of the breast. There are several types of nipple biopsy:

    • Surface biopsy: A glass slide or other tool is used to gently scrape cells from the surface of the skin.
    • Shave biopsy: A razor-like tool is used to remove the top layer of skin.
    • Punch biopsy: A circular cutting tool, called a punch, is used to remove a disk-shaped piece of tissue.
    • Wedge biopsy: A scalpel is used to remove a small wedge of tissue.

    If the affected area is quite small, it may be completely removed - it is then called an excision biopsy.

    Development of Paget's Disease of the Nipple/Breast

  • Swab from Nipple Discharge: If nipple discharge is present, a sample can be picked up on a swab and examined under a microscope for the presence of Paget's cells.

  • Scrape cytopathology: Scrape or immune cytology consists of scraping the cells from the rash and examining them under a microscope.

  • Screening Mammography: Mammography is effective in identifying other underlying types of breast cancers like invasive ductal breast cancer(IDC) and invasive lobular breast cancer (ILC). Very often, Ductal breast cancer in situ (DCIS) may be present in the breast ducts although no symptoms of breast cancers like lumps or nipple discharge is present. Mammograms can pick up microscopic breast changes that might be associated with DCIS. These breast changes are usually due to deposits of calcium called microcalcifications.

  • Diagnostic Mammography: If microcalcifications are seen on the screening mammogram, a more detailed study of the breast called diagnostic mammogram, which takes views at higher magnification and from more angles, may be needed.

  • Ultrasound of the breast: Ultrasound imaging, also known as ultrasonography or sonogram, produces a picture of the internal structures of the breast and can help identify a breast mass and its characteristics. A special type of ultrasound, known as Doppler ultrasound can evaluate blood flow or lack of blood flow in any breast mass. A malignant mass will have more blood flow than normal tissue.

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