Hye Young Choi MD, Presenter: Nothing to Disclose

Nariya Cho MD, Abstract Co-Author: Nothing to Disclose

Woo Kyung Moon MD, Abstract Co-Author: Nothing to Disclose

Sun Mi Kim MD, PhD, Abstract Co-Author: Nothing to Disclose

Eun Sook Ko MD, Abstract Co-Author: Nothing to Disclose

To evaluate the role of preoperative breast MRI in the assessment of disease extent for patients with Paget disease (PD) of the nipple using surgical histology as the reference standard

Between August 2005 and May 2009, 30 patients with biopsy proven PD were identified at our institution. Four patients who had not undergo breast MRI and 6 patients with a palpable symptom were excluded. A total of 20 patients (mean age 57 years, range 40-81 years) with biopsy proven PD who underwent mammography, breast MRI, and subsequent surgery were included. Lesion type [the disease confined to nipple areolar complex (NAC) and the disease involving parenchyma at least 20 mm away from the NAC] and lesion size were assessed and compared between by mammography and MRI. They were correlated with surgical histologic results.  

Surgical histology revealed 9 invasive ductal carcinomas and 11 lesions of ductal carcinoma in situ. Of the 20 lesions, 4 lesions (20 %) were confined to NAC and 16 lesions (80%) had other malignant focus than NAC. For the detection of other malignant focus than NAC, MRI showed significant correlation (r = 0.764, p < 0.001) with surgical histology, but mammography did not (r = 0.419, p = 0.066). However, the sensitivity (87.5% versus 75.0%; p = 0.481), specificity (100.0% versus75.0%; p = 0.592), positive predictive value (100.0% versus 92.3%; p = 0.654), and negative predictive value (66.7% versus 42.9%; p = 1.000) of MRI and mammography were similar. For the assessment of lesion size, both the MRI and mammography showed significant correlation with surgical histology (r=0.811 versus 0.490; p<0.05).

Preoperative breast MRI is more accurate in the assessment of lesion extent for patients with PD than mammography. However, negative MRI does not reliably exclude other malignant foci than NAC.

MRI can be useful in detecting other malignant focus than NAC when there is no clinical sign nor a suspicious mammography, and might therefore facilitate appropriate surgical treatment planning.

Choi, H, Cho, N, Moon, W, Kim, S, Ko, E, Role of Preoperative Breast MRI in Patients with Paget Disease of the Nipple.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014500.html