Ceccherini A F, Evans A J, Pinder S E, Wilson A R, Ellis I O, Yeoman L J
Department of Radiology, City Hospital, Nottingham, UK.
Clin Radiol. 1996 Jan;51(1):35-8. doi: 10.1016/s0009-9260(96)80216-9.
To identify the clinical value of pre-operative ipsilateral mammography in patients with Paget's disease of the breast.
The mammograms and histological data of 27 patients with Paget's disease and 60 patients with symptomatic DCIS without Paget's disease were reviewed and compared.
Forty-four percent of patients with Paget's disease had normal mammograms. Mammography did not discriminate between DCIS and invasive disease, and could not predict DCIS sub-type. DCIS was large cell in 80% of patients with Paget's disease. Given that large cell DCIS in non Paget's patients is normally visible mammographically, the large proportion of Paget's patients with normal mammography is difficult to explain, but could be due to the small size of the lesions. Comparison of the Paget's and non-Paget's groups showed that large cell solid disease was more common, small cell cribriform less common and normal mammography more common in the Paget's group. Given that mastectomy is the treatment of choice, the only clinical value of ipsilateral mammography in our unit would be to allow image guided core biopsy of any detected mammographic abnormalities to determine the presence of invasive disease prior to surgery, thus indicating the need for node sampling pre-operatively rather than as a delayed procedure. This study also confirms that mammography is of little help in deciding if breast conserving surgery is appropriate for individual cases of Paget's disease of the nipple due to the insensitivity of mammography in showing the site of disease.
确定术前同侧乳房钼靶摄影在乳腺佩吉特病患者中的临床价值。
回顾并比较了27例佩吉特病患者和60例有症状但无佩吉特病的导管原位癌（DCIS）患者的乳房钼靶摄影图像和组织学数据。
44%的佩吉特病患者乳房钼靶摄影结果正常。乳房钼靶摄影无法区分DCIS和浸润性疾病，也无法预测DCIS的亚型。在80%的佩吉特病患者中，DCIS为大细胞型。鉴于非佩吉特病患者中的大细胞型DCIS通常在乳房钼靶摄影中可见，佩吉特病患者中乳房钼靶摄影正常的比例较高难以解释，但可能是由于病变较小。佩吉特病组与非佩吉特病组的比较显示，大细胞实性疾病在佩吉特病组中更常见，小细胞筛状疾病在佩吉特病组中较少见，乳房钼靶摄影正常在佩吉特病组中更常见。鉴于乳房切除术是首选治疗方法，在我们单位，同侧乳房钼靶摄影的唯一临床价值是对任何检测到的乳房钼靶异常进行图像引导下的核心活检，以在手术前确定浸润性疾病的存在，从而表明术前需要进行淋巴结采样，而不是作为延迟程序。这项研究还证实，由于乳房钼靶摄影在显示疾病部位方面不敏感，因此在决定保乳手术是否适用于个别乳头佩吉特病病例时，乳房钼靶摄影帮助不大。
