Paget Disease of the Breast: Mammography, US, and MRI

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 2.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Image Production: 0.50
Evaluation and Selection of Representative Images: 0.50
Procedures: 2.00
Anatomy and Physiology: 0.50
Pathology: 1.25
Breast Interventions: 0.25

Mammography: 2.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 2.50
Anatomy, Physiology, and Pathology: 1.75
Mammographic Positioning, Special Needs, and Imaging Procedures: 0.75

Magnetic Resonance Imaging: 1.75
Procedures: 1.75
Body: 1.75

Nuclear Medicine Technology: 1.75
Procedures: 1.75
Endocrine and Oncology Procedures: 1.75

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Thoracic Section: 2.75

Sonography: 1.75
Procedures: 1.75
Superficial Structures and Other Sonographic Procedures: 1.75

Radiation Therapy: 2.75
Patient Care: 1.00
Patient and Medical Record Management: 1.00
Procedures: 1.75
Treatment Sites and Tumors: 1.75

Outline

1. Introduction
2. Histopathologic Features
3. Pathogenesis
4. Clinical Manifestations
5. Differential Diagnosis of Nipple Changes
6. Classification
7. Diagnosis
   1. Mammography
   2. Ultrasonography
   3. MR Imaging
8. Management
9. Conclusions

Objectives

Upon completion of this course, students will:

1. know the importance of associated underlying breast cancer with Paget disease of the nipple/breast
2. understand the likelihood of occurrence of invasive (advanced) cancer occurring with PDB
3. know the importance of using the appropriate procedures to demonstrate occult cancer
4. recognize the histologic appearance of Paget Cells
5. know the histologic features of Paget cells
6. understand the theory of the pathogenic pathway of Paget Disease
7. understand the rationale of the epidermotropic theory of Paget disease
8. be able to describe the theory of epidermotropic theory of Paget disease
9. understand the intraepidermal transformation theory of pathogenesis of Paget disease
10. know the factors that support this theory
11. understand the importance of skin changes around the nipple with PDB
12. know the significance of nipple changes with PDB
13. know the risk of cancer associated with PDB
14. understand the importance of the presence of a mass which is suspicious of cancer
15. recognize that the associated cancer with PDB is often advanced
16. recognize that there are differences between benign eczema and PD of the nipple
17. know that steroids may be used as treatment for both benign eczema and Paget disease
18. select the appropriate procedure for accurate diagnosis of either Bowen’s or Paget Disease
19. select the appropriate examination for diagnosis of nipple changes
20. know the importance of the incidence of cancer with PDB of the nipple
21. know the theory that supports this low incidence of PDB of the nipple and cancer
22. recognize the most important procedure to diagnose skin involvement
23. know the correct choice of imaging for diagnosis
24. differentiate between nipple findings and breast parenchymal findings
25. recognize the findings in the breast parenchymal tissues
26. know the percentage of patients who present with PDB and a normal mammogram
27. the reason for using ultrasonography
28. know one of the roles of MR imaging for PDB
29. know the reasons for using MRI in evaluating patients with PDB
30. know one of the roles of MRI for nipple imaging
31. know a further indication for the use of MRI for PDB
32. know the indication for MRI guided biopsy of the breast with PDB
33. know the historic standard of treatment for PDB
34. know the factors that affect prognosis after initial diagnosis
35. recognize the treatment/management for patients with PDB and advanced (invasive) cancer of the breast