Paget's Disease of the Breast: A Single-Center Experience

Background: Paget’s disease of the breast (PDB) is an unusual lesion that affects the nipple-areolar complex of the breast and is associated with heterogeneous clinical characteristics [1]. The incidence of PDB accounts for only 1-3% of total primary breast carcinomas and occurs more frequently in postmenopausal women [2]. In this study, we present the experience of our Oncology Department regarding the diagnosis and treatment characteristics of patients with PDB. Methods: Data from consecutive patients with histologically proven Paget’s disease of the breast treated in the Oncology Institute of the Republic of Moldova from January 2019 to December 2023 were retrospectively collected. The study did not include metastatic cases. Results: Twenty-two patients were included in the study. They were between 47 and 81 years old, and 16 (72.7%) were between 51 and 70 years old. Most patients were diagnosed with stage III (n=14; 63.6 %). The condition was predominantly detected through breast self-examination (BSE) (n=12; 54.5%) or breast cancer screening (n=7; 31.8%). All patients underwent an ultrasound of the breast with regional lymph nodes and mammography. The diagnosis was confirmed in 63.6% (n=14) through cytological examination by smear-imprint and core needle biopsies of the tumor in 63%. The predominant forms were Paget breast carcinoma with invasive ductal carcinoma (n=14; 63.6%), with a poorly differentiated grade G3 (n=17; 77.2%). Five cases (22.7%) had Luminal A, and fifteen cases (68.1%) had Luminal B histology. The surgical treatment involved modified radical mastectomy with axillary lymph node dissection in all cases. Adjuvant radiotherapy was performed in 31.8%, chemotherapy in 54.5%, and endocrine therapy in 63.6%. Conclusion: In our study population, PDB was often diagnosed in advanced stages, being associated with poorly differentiated Luminal A and B invasive ductal carcinoma and was treated by radical mastectomy followed by chemotherapy and radiotherapy (according to indications).