Paget's disease of the breast biopsy: Difference between revisions
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==Overview== | ==Overview== | ||
A full-thickness biopsy of the [[nipple]] and areola is important for establishing the diagnosis of Paget's disease of the [[breast]]. Findings on [[biopsy]] diagnostic of Paget's disease of the breast include presence of Paget cells, which are arranged in solid groups. | A full-thickness [[biopsy]] of the [[nipple]] and [[areola]] is important for establishing the diagnosis of Paget's disease of the [[breast]]. Findings on [[biopsy]] diagnostic of Paget's disease of the breast include presence of Paget cells, which are arranged in [[solid]] groups. | ||
==Biopsy== | ==Biopsy== | ||
*The diagnosis of Paget's disease can be made from a [[Biopsy|wedge biopsy]], a superficial shave [[biopsy]] of [[epidermis]] or from a punch [[biopsy]]. | *The diagnosis of Paget's disease can be made from a [[Biopsy|wedge biopsy]], a superficial shave [[biopsy]] of [[epidermis]] or from a punch [[biopsy]].<ref name="pmid8912355">{{cite journal |vauthors=Gupta RK, Simpson J, Dowle C |title=The role of cytology in the diagnosis of Paget's disease of the nipple |journal=Pathology |volume=28 |issue=3 |pages=248–50 |date=August 1996 |pmid=8912355 |doi= |url=}}</ref> | ||
*Wedge [[biopsy]] is the most useful method to make the diagnosis because the [[biopsy]] is likely to include the [[epidermis]] and a part of [[lactiferous duct]]. | *Wedge [[biopsy]] is the most useful method to make the diagnosis because the [[biopsy]] is likely to include the [[epidermis]] and a part of [[lactiferous duct]]. | ||
*It is essential that the sample contains part of the [[lactiferous duct]] and if the [[areola]] is affected, it also needs to be represented in the [[sample]] to confirm the [[diagnosis]]. | *It is essential that the sample contains part of the [[lactiferous duct]] and if the [[areola]] is affected, it also needs to be represented in the [[sample]] to confirm the [[diagnosis]].<ref name="pmid7529588">{{cite journal |vauthors=Lucarotti ME, Dunn JM, Webb AJ |title=Scrape cytology in the diagnosis of Paget's disease of the breast |journal=Cytopathology |volume=5 |issue=5 |pages=301–5 |date=October 1994 |pmid=7529588 |doi= |url=}}</ref> | ||
*A shave [[biopsy]] is less likely to contain sufficient number of Paget's cells, especially when the surface of the [[lesion]] is [[Ulcer|ulcerated]]. | *A shave [[biopsy]] is less likely to contain sufficient number of Paget's cells, especially when the surface of the [[lesion]] is [[Ulcer|ulcerated]]. | ||
*A punch [[biopsy]] will include the underlying [[stroma]] and possibly part of a [[duct]]. It frequently provides less [[epidermis]] to examine. | *A punch [[biopsy]] will include the underlying [[stroma]] and possibly part of a [[duct]]. It frequently provides less [[epidermis]] to examine. | ||
*Many times a full-thickness [[biopsy]] of the [[nipple]] and [[areola]] is important for establishing the diagnosis of Paget's disease of the [[breast]]. | *Many times a full-thickness [[biopsy]] of the [[nipple]] and [[areola]] is important for establishing the diagnosis of Paget's disease of the [[breast]]. | ||
* This is especially in a patient with [[nipple]]–[[areola]] [[skin]] changes.<ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref> <ref>{{cite book | last = Rosen | first = Paul | title = Rosen's breast pathology | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2014 | isbn = 9781451176537 }}</ref> | * This is especially in a patient with [[nipple]]–[[areola]] [[skin]] changes.<ref name="Lopes FilhoLopes2015">{{cite journal|last1=Lopes Filho|first1=Lauro Lourival|last2=Lopes|first2=Ione Maria Ribeiro Soares|last3=Lopes|first3=Lauro Rodolpho Soares|last4=Enokihara|first4=Milvia M. S. S.|last5=Michalany|first5=Alexandre Osores|last6=Matsunaga|first6=Nobuo|title=Mammary and extramammary Paget's disease|journal=Anais Brasileiros de Dermatologia|volume=90|issue=2|year=2015|pages=225–231|issn=1806-4841|doi=10.1590/abd1806-4841.20153189}}</ref><ref>{{cite book | last = Rosen | first = Paul | title = Rosen's breast pathology | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2014 | isbn = 9781451176537 }}</ref> | ||
*[[Biopsy]] is not always successful, therefore, it is at times necessary to take a second [[biopsy]] or to excise the [[nipple]]. | *[[Biopsy]] is not always successful, therefore, it is at times necessary to take a second [[biopsy]] or to excise the [[nipple]]. | ||
*Often [[histological]] exams are inconclusive and more [[Biopsy|biopsies]], or even surgical removal of the entire [[nipple]] may be required. | *Often [[histological]] exams are inconclusive and more [[Biopsy|biopsies]], or even surgical removal of the entire [[nipple]] may be required. | ||
Latest revision as of 15:25, 27 March 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]
Overview
A full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget's disease of the breast. Findings on biopsy diagnostic of Paget's disease of the breast include presence of Paget cells, which are arranged in solid groups.
Biopsy
- The diagnosis of Paget's disease can be made from a wedge biopsy, a superficial shave biopsy of epidermis or from a punch biopsy.[1]
- Wedge biopsy is the most useful method to make the diagnosis because the biopsy is likely to include the epidermis and a part of lactiferous duct.
- It is essential that the sample contains part of the lactiferous duct and if the areola is affected, it also needs to be represented in the sample to confirm the diagnosis.[2]
- A shave biopsy is less likely to contain sufficient number of Paget's cells, especially when the surface of the lesion is ulcerated.
- A punch biopsy will include the underlying stroma and possibly part of a duct. It frequently provides less epidermis to examine.
- Many times a full-thickness biopsy of the nipple and areola is important for establishing the diagnosis of Paget's disease of the breast.
- This is especially in a patient with nipple–areola skin changes.[3][4]
- Biopsy is not always successful, therefore, it is at times necessary to take a second biopsy or to excise the nipple.
- Often histological exams are inconclusive and more biopsies, or even surgical removal of the entire nipple may be required.
- The main histological characteristic is the presence of Paget cells, which are arranged in solid groups.
- On occasion, they form glandular arrangements outlining the basal epidermis and exhibit migration to the granular layer, similarly to melanocytes.
To view histopathologic characteristic features of Paget's disease of the breast, click here.
References
- ↑ Gupta RK, Simpson J, Dowle C (August 1996). "The role of cytology in the diagnosis of Paget's disease of the nipple". Pathology. 28 (3): 248–50. PMID 8912355.
- ↑ Lucarotti ME, Dunn JM, Webb AJ (October 1994). "Scrape cytology in the diagnosis of Paget's disease of the breast". Cytopathology. 5 (5): 301–5. PMID 7529588.
- ↑ Lopes Filho, Lauro Lourival; Lopes, Ione Maria Ribeiro Soares; Lopes, Lauro Rodolpho Soares; Enokihara, Milvia M. S. S.; Michalany, Alexandre Osores; Matsunaga, Nobuo (2015). "Mammary and extramammary Paget's disease". Anais Brasileiros de Dermatologia. 90 (2): 225–231. doi:10.1590/abd1806-4841.20153189. ISSN 1806-4841.
- ↑ Rosen, Paul (2014). Rosen's breast pathology. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781451176537.