Paget disease of the nipple as a marker of multifocal, higher-risk underlying breast cancer
This pathological study found that the cancer underlying Paget disease of the nipple is often multifocal and spread away from the nipple, which is why full imaging and careful surgical planning are needed rather than simple nipple excision.
Overview
Review of 70 mastectomy specimens with Paget disease of the nipple, mapping the extent and location of the underlying in situ and invasive carcinoma.
Most cases had underlying carcinoma, frequently multifocal and often distant from the nipple, with a high proportion of high-grade and HER2-positive tumours, arguing that Paget disease marks a higher-risk breast.
Breast MRI to map disease and central excision with clear margins or mastectomy, rather than removing the nipple alone, follow from findings like these.
- Single-institution mastectomy series, which selects for more extensive disease.