Treatment of Paget Disease of Breast with Palpable Breast Lump and Underlying Ductal Carcinoma In Situ
This protocol applies to Paget's disease of the nipple-areolar complex presenting alongside a palpable mass in the same breast, where imaging identifies the lump in the retroareolar region and biopsy confirms an underlying low-grade ductal carcinoma in situ (DCIS).
Clinical scenario
Paget's disease of the nipple-areolar complex with an associated solitary palpable breast lump — localised on imaging to the retroareolar region — in which core needle biopsy of the lump is consistent with low-grade DCIS and full-thickness biopsy of the nipple-areolar complex confirms Paget's disease. Both findings must be accounted for in the management plan.
Treatment approach (partial summary)
The protocol centres on breast conservation surgery as the primary surgical step, with axillary assessment decisions incorporated based on clinical and imaging context. Adjuvant locoregional therapy forms part of the plan, and receptor status on histology may direct further systemic management. The complete sequencing, decision points, and criteria are detailed in the full structured protocol.
References
- In other scenario there was an associated, solitary lump, size 2.5 cm × 2.0 cm, found on imaging in retroareolar region of the same breast
- Core needle biopsy of the lump was s/o low grade DCIS and full thickness biopsy of NAC revealed Pagets' disease
- Breast conservation surgery with or without SLNB.
- Expert panel recommended giving radiotherapy in adjuvant setting
- Expert panel recommended lumpectomy followed by APBI if lymph node biopsy is not done
- If histology confirms DCIS plus ER and/or PR is positive, hormonal treatment is recommended
DOI: 10.4103/sajc.sajc_107_18
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