Zakaria Shaheen, Pantvaidya Gouri, Ghosh Karthik, Degnim Amy C
Department of General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Breast Cancer Res Treat. 2007 Apr;102(2):137-42. doi: 10.1007/s10549-006-9329-2. Epub 2006 Sep 21.
Routine preoperative assessment may not accurately assess the extent of underlying cancer in patients with Paget's disease (PD) of the breast. We performed this study to correlate findings on clinical examination and mammography with pathologic results and outcomes in women with PD.
An IRB-approved retrospective review identified all patients with PD between 1975 and 2000. Clinical exam and mammographic findings were recorded, and information on recurrence and survival was obtained from medical records.
Univariate analyses identified palpable mass and suspicious mammogram as risk factors significantly associated with a worse outcome. Patients were therefore categorized by combinations of these two preoperative factors. All patients with a palpable mass and a suspicious mammogram had invasive cancer. In the subgroup of 40 women with a benign mammogram and no palpable mass, invasive cancer occurred in 5% and the majority (68%) had ductal carcinoma in situ which extended beyond the nipple. Women with a palpable mass and a suspicious mammogram had significantly worse survival compared to those with a benign mammogram and no palpable mass (P = 0.008). With a median follow-up of 6.4 years, five local recurrences occurred in patients with invasive cancer who underwent mastectomy.
In women with PD, a palpable mass or suspicious mammogram portends a high likelihood of invasive cancer. Underlying cancer is common even in women with a benign mammogram and no palpable mass. Although breast conservation is an attractive option in patients with PD, mammography and physical exam may significantly underestimate the presence and extent of underlying disease.
常规术前评估可能无法准确评估乳腺佩吉特病（PD）患者潜在癌症的范围。我们开展这项研究，旨在将临床检查和乳腺X线摄影结果与PD女性患者的病理结果及预后相关联。
一项经机构审查委员会批准的回顾性研究确定了1975年至2000年间所有PD患者。记录临床检查和乳腺X线摄影结果，并从病历中获取复发和生存信息。
单因素分析确定可触及肿块和可疑乳腺X线摄影为与较差预后显著相关的危险因素。因此，根据这两个术前因素的组合对患者进行分类。所有有可触及肿块且乳腺X线摄影可疑的患者均患有浸润性癌。在40名乳腺X线摄影为良性且无可触及肿块的女性亚组中，5%发生了浸润性癌，大多数（68%）患有超出乳头范围的导管原位癌。有可触及肿块且乳腺X线摄影可疑的女性与乳腺X线摄影为良性且无可触及肿块的女性相比，生存情况明显更差（P = 0.008）。中位随访6.4年，接受乳房切除术的浸润性癌患者中有5例发生局部复发。
在PD女性中，可触及肿块或可疑乳腺X线摄影预示浸润性癌的可能性很高。即使在乳腺X线摄影为良性且无可触及肿块的女性中，潜在癌症也很常见。尽管保乳对PD患者是一个有吸引力的选择，但乳腺X线摄影和体格检查可能会显著低估潜在疾病的存在和范围。
