Clinical diagnosis and treatment of Paget disease of breast

Abstract

Objective To investigate early diagnosis and treatment of Paget disease of breast. Methods The clinicopathological data of 26 cases of breast Paget disease in the First Affiliated Hospital of Wenzhou Medical University from January 1995 to June 2018 was analyzed. Results The main clinical manifestation of 26 patients was eczema like papillae in 19 cases (73.1%), and associated with nipple discharge in 9 cases (34.6%) and breast mass in 6 cases (23.1%). The diagnosis of this disease was based on curettage cytology in 4 cases (15.4%), biopsy in 8 cases (30.8%), and needle aspiration cytology or post resection pathological examination in 14 cases (53.8%). Paget disease consisted of simple papillary Paget disease in 3 cases (11.5%), ductal carcinoma in 18 cases (69.2%) and invasive ductal carcinoma in 5 cases (19.2%). Pathological TNM staging was 0 stage in 19 cases (73.1%), stage Ⅰ in 3 cases (11.5%), stage Ⅱin 2 cases (7.7%), stage Ⅲ in 2 cases (7.7%) and no stage in Ⅳ case. In this group, 2 cases underwent radical mastectomy, 18 cases underwent modified radical mastectomy, 4 cases underwent simple mastectomy, and 2 cases underwent mastectomy combined with low axillary lymph node dissection and intraoperative rapid frozen examination. Fourteen patients received adjuvant chemotherapy with CEF(cyclophosphamide+ pharmorubicin+tegafur)/EC(pharmorubicin+cyclophosphamide)+T(docetaxel) or TP(docetaxel+cis-platinum)regiment after operation, 2 cases were treated with trastuzumab targeted therapy and 5 cases with adjuvant radiotherapy. Twenty-five of 26 patients were followed up for 8-108 months except one patient lost in follow-up. The 5-year survival rate was 96.0% (24/25), and the 10-year survival rate was 52.0% (13/25). Conclusions The diagnosis of Paget disease of the breast depends on cytology or pathology, and multidisciplinary treatment based on surgery is judged of by tumor stage and coincident other types of breast cancer and axillary lymph node involvement. Key words: Paget disease; Papilla eczema like breast cancer; Treatment outcome