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Diagnosis and treatment of Paget's disease of the breast: an analysis of 72 cases.

OBJECTIVE
Clinical features, prognostic factors and principle of surgical treatment for Paget's disease of the breast were analyzed, so as to optimize the treatment of Pagent's disease of the breast.


METHOD
Seventy-two cases of Paget's disease of the breast treated at Affiliated Union Hospital and Hospital of Integrated Traditional Chinese and Western Medicine, Huazhong University of Science and Technology, from January 1991 to January 2010 were recruited. Their clinical data were analyzed retrospectively.


RESULTS
Among 72 cases, 52 cases had nipple-areolar complex lesions, 43 had palpable masses and 18 had palpable, enlarged axillary lymph nodes; 45 cases received radical mastectomy or modified radical mastectomy. Intraoperative pathological examination was performed for 9 cases who were not discovered to have breast lumps or enlarged axillary lymph nodes preoperatively; and 4 of them were diagnosed as lower axillary lymph node metastasis or invasive ductal carcinoma, and modified radical mastectomy was adopted for these cases. Fifty-two cases received postoperative pathological examination to reveal that the average number of metastatic lymph nodes was 3.1. Among the cases presenting with lymph node metastases, those negative for ER/PR accounted for 78%; Her-2-positive cases accounted for 56%. Thirty-seven cases were followed up for an average of 29 months postoperatively, and 5 of them were found with local recurrence and 7 with distant metastases.


CONCLUSION
Most cases of Paget's disease of the breast were associated with invasive ductal carcinoma and lymph node metastases. These cases had low ER/PR positive rate, high Her-2 positive rate and poor prognosis.