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Paget’s Disease as a Local Recurrence after Nipple-Sparing Mastectomy: Clinical Presentation, Treatment, Outcome, and Risk Factor Analysis

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Paget’s disease is a rare clinical and histological type of local recurrence (LR) after breast cancer treatment both in case of conservative surgery or nipple-sparing mastectomy (NSM) with or without intraoperative radiation.

Methods

We performed an analysis of 861 NSM with electron beam intraoperative radiotherapy (ELIOT) patients treated at the European Institute of Oncology from 2002 to 2008, focused on Paget’s disease local recurrence.

Results

In 861 patients (713 invasive carcinoma and 148 intraepithelial neoplasia), there were 36 local recurrences (4.18%), and among these were 7 Paget’s disease local recurrences (0.8%). Median follow-up was 50 months. Four cases presented with nipple areola complex (NAC) erosions, two crusted lesions, and one ulcerated NAC. The average latency period from the NSM to Paget’s disease local recurrence is 32 months (range, 12–49). Complete NAC removal was performed in all seven recurrences. The average follow-up after NAC removal was 47.4 months (range, 20–78). We found neither locoregional relapse nor metastatic event in this group. All patients were alive without disease.

Conclusions

Paget’s disease local recurrence can be found in a significant proportion after NSM. Any suspicious lesion on NAC requires prompt pathological confirmation. Primary carcinoma with ductal intraepithelial neoplasia or invasive ductal carcinoma with extensive in situ component, negative hormonal receptor, high pathological grade, overexpression of HER2/neu, and “HER2 positive (nonluminal)” subtype tend to be significantly associated with more Paget’s disease local recurrence and should be followed carefully.

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References

  1. Paget J. On disease of the mammary areola preceding cancer of mammary gland. St Bartholomew’s Hosp Rep. 1874;10:87–9.

    Google Scholar 

  2. Ashikari R, Park K, Huvos AG, Urban JA. Paget’s disease of the breast. Cancer. 1970;26:680–5.

    Article  PubMed  CAS  Google Scholar 

  3. Fu W, Mittel VK, Young SC. Paget disease of the breast: analysis of 41 patients. Am J Clin Oncol. 2001;24:397–400.

    Article  PubMed  CAS  Google Scholar 

  4. Muir R. Pathogenesis of Paget’s disease of the nipple and associated lesions. Br J Surg. 1935;22:728–37.

    Article  Google Scholar 

  5. Inglis K. Paget’s disease of the nipple; with special reference to the changes in the ducts. Am J Pathol. 1946;22:1–33.

    Google Scholar 

  6. Mendez-Fernandez MA, Henly WS, Geis RC, et al. Paget’s disease of the breast after subcutaneous mastectomy and reconstruction with a silicone prosthesis. Plast Reconstr Surg. 1980;65:683–5.

    Article  PubMed  CAS  Google Scholar 

  7. Shearman CP, Watts GT. Paget’s disease of the nipple after subcutaneous mastectomy for cancer with primary reconstruction. Ann R Coll Surg Engl. 1986;68:17–8.

    PubMed  CAS  Google Scholar 

  8. Menzies D, Barr L, Ellis H. Paget’s disease of the nipple occurring after wide local excision and radiotherapy for carcinoma of the breast. Eur J Surg Oncol. 1989;15:271–3.

    PubMed  CAS  Google Scholar 

  9. Schnitt SJ, Connolly JL, Recht A, et al. Breast relapse following primary radiation therapy for early breast cancer. II. Detection, pathologic features and prognostic significance. Int J Radiat Oncol Biol Phys. 1985;11:1277–84.

    Article  PubMed  CAS  Google Scholar 

  10. Peterse JL, van Dongen JA, Bartelink H. Recurrence of breast carcinoma after breast conserving treatment. Eur J Surg Oncol. 1988;14:123–6.

    PubMed  CAS  Google Scholar 

  11. Plastaras JP, Harris EE, Solin LJ. Paget’s disease of the nipple as local recurrence after breast-conservation treatment for early-stage breast cancer. Clin Breast Cancer. 2005;6:349–53.

    Article  PubMed  Google Scholar 

  12. Harness JK, Vetter TS, Salibian AH. Areola and nipple-areola-sparing mastectomy for breast cancer treatment and risk reduction: report of an initial experience in a community hospital setting. Ann Surg Oncol. 2011;18:917–22.

    Article  PubMed  Google Scholar 

  13. Petit JY, Veronesi U, Orecchia R, et al. Nipple sparing mastectomy with nipple areola intraoperative radiotherapy: one thousand and one cases of a five years experience at the European institute of oncology of Milan (EIO). Breast Cancer Res Treat. 2009;117:333–8.

    Article  PubMed  CAS  Google Scholar 

  14. Petit JY, Veronesi U, Orecchia R, et al. The nipple-sparing mastectomy: early results of a feasibility study of a new application of perioperative radiotherapy (ELIOT) in the treatment of breast cancer when mastectomy is indicated. Tumori. 2003;89:288–91.

    PubMed  Google Scholar 

  15. Rusby JE, Smith BL, Gui GP. Nipple-sparing mastectomy. Br J Surg. 2010;97:305–16.

    Article  PubMed  CAS  Google Scholar 

  16. Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat. 2009;118:623–33.

    Article  PubMed  CAS  Google Scholar 

  17. Algaithy ZK, Petit JY, Lohsiriwat V, et al. Nipple sparing mastectomy: Can we predict the factors predisposing to necrosis? Eur J Surg Oncol. 2012;38(2):125–9.

    PubMed  CAS  Google Scholar 

  18. Petit JY, Veronesi U, Lohsiriwat V, et al. Nipple-sparing mastectomy—is it worth the risk? Nat Rev Clin Oncol. 2011;8(12):742–7.

    Article  PubMed  Google Scholar 

  19. Orecchia R, Ciocca M, Lazzari R, et al. Intraoperative radiation therapy with electrons (ELIOT) in early-stage breast cancer. Breast. 2003;12:483–90.

    Article  PubMed  CAS  Google Scholar 

  20. Jamali FR, Ricci A Jr, Deckers PJ. Paget’s disease of the nipple-areola complex. Surg Clin North Am. 1996;76:365–81.

    Article  PubMed  CAS  Google Scholar 

  21. Sukumvanich P, Bentrem DJ, Cody HS 3rd, et al. The role of sentinel lymph node biopsy in Paget’s disease of the breast. Ann Surg Oncol. 2007;14:1020–3.

    Article  PubMed  CAS  Google Scholar 

  22. Laronga C, Hasson D, Hoover S, et al. Paget’s disease in the era of sentinel lymph node biopsy. Am J Surg. 2006;192:481–3.

    Article  PubMed  Google Scholar 

  23. Chen CY, Sun LM, Anderson BO. Paget disease of the breast: changing patterns of incidence, clinical presentation, and treatment in the U.S. Cancer. 2006;107:1448–58.

    Article  PubMed  Google Scholar 

  24. Caliskan M, Gatti G, Sosnovskikh I, et al. Paget’s disease of the breast: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat. 2008;112:513–21.

    Article  PubMed  Google Scholar 

  25. Wolber RA, Dupuis BA, Wick MR. Expression of c-erbB-2 oncoprotein in mammary and extramammary Paget’s disease. Am J Clin Pathol. 1991;96:243–7.

    PubMed  CAS  Google Scholar 

  26. Lovekin C, Ellis IO, Locker A, et al. c-erbB-2 oncoprotein expression in primary and advanced breast cancer. Br J Cancer. 1991;63:439–43.

    Article  PubMed  CAS  Google Scholar 

  27. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes–dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22:1736–47.

    Article  PubMed  CAS  Google Scholar 

  28. Fu W, Lobocki CA, Silberberg BK, et al. Molecular markers in Paget disease of the breast. J Surg Oncol. 2001;77:171–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

V. Lohsiriwat, M. Sommario, and M. Cassilha received grant young investigator program support by Fondazione Umberto Veronesi.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, European Institute of Oncology, Milan, Italy

    Visnu Lohsiriwat, Stefano Martella, Mario Rietjens, Cristina Garusi, Francesca De Lorenzi, Andrea Manconi, Maria Sommario, Benedetta Barbieri, Maximiliano Cassilha, Ilaria Minotti & Jean Yves Petit

  2. Department of Surgery, Faculty of Medicine Mahidol University, Siriraj Hospital, Bangkok, Thailand

    Visnu Lohsiriwat

  3. Epidemiology and Statistics, European Institute of Oncology, Milan, Italy

    Edoardo Botteri & Nicole Rotmensz

  4. Department of Pathology, European Institute of Oncology, Milan, Italy

    Mauro Giuseppe Mastropasqua

Authors
  1. Visnu Lohsiriwat
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  2. Stefano Martella
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  7. Cristina Garusi
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  11. Benedetta Barbieri
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  12. Maximiliano Cassilha
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  13. Ilaria Minotti
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  14. Jean Yves Petit
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Correspondence to Jean Yves Petit.

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Lohsiriwat, V., Martella, S., Rietjens, M. et al. Paget’s Disease as a Local Recurrence after Nipple-Sparing Mastectomy: Clinical Presentation, Treatment, Outcome, and Risk Factor Analysis. Ann Surg Oncol 19, 1850–1855 (2012). https://doi.org/10.1245/s10434-012-2226-5

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  • DOI: https://doi.org/10.1245/s10434-012-2226-5

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