Background: Surgical management for Paget's disease (PD) of the breast is controversial. This study aims to assess outcomes of PD patients based on procedure type and determine the reliability of imaging in estimating disease extent.
Methods: A retrospective review analyzed clinicopathologic data of PD patients between 2009 and 2022. Pre-operative imaging size (PIS) was compared to post-operative pathology size (PPS) looking at concordance.
Results: Thirty patients had PD, 21 underwent total mastectomy (TM) and 9 breast conserving surgery (BCS). Seventeen patients (56.7 %) had a final diagnosis of invasive cancer (14 TM, 3 BCS), with no local recurrences. Only 6/19 (31.6 %) patients with positive findings on ultrasound/mammogram had concordance between PIS and PPS. There were no breast/chest wall recurrences with a median follow up of 35.9 months.
Conclusion: Ultrasound and mammogram had poor concordance with pathological size. BCS is feasible in select patients. MRI may help guide management.
Keywords: Outcome; Paget's disease of breast; Pre-operative imaging; Treatment.
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