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

Clinical manifestations and imaging findings of Paget Disease at mammography, US and MR imaging are presented.

Course ID: Q00356 Category:
Modalities: , , ,

2.5

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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: 2.50
Patient Care: 0.25
Patient Interactions and Management: 0.25
Image Production: 0.50
Evaluation and Selection of Representative Images: 0.50
Procedures: 1.75
Anatomy and Physiology: 0.50
Pathology: 1.00
Breast Interventions: 0.25

Mammography: 2.50
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 2.25
Anatomy, Physiology, and Pathology: 1.50
Mammographic Positioning, Special Needs, and Imaging Procedures: 0.75

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Body: 1.50

Nuclear Medicine Technology: 1.50
Procedures: 1.50
Endocrine and Oncology Procedures: 1.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Thoracic Section: 2.50

Sonography: 1.50
Procedures: 1.50
Superficial Structures and Other Sonographic Procedures: 1.50

Radiation Therapy: 2.50
Patient Care: 1.00
Patient and Medical Record Management: 1.00
Procedures: 1.50
Treatment Sites and Tumors: 1.50

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