Paget’s disease of the breast is a rare form of breast cancer that typically starts in the nipple and can affect the surrounding area. Diagnosing Paget’s disease involves several steps:
1. **Clinical Examination**: The diagnosis often starts with a physical examination by a healthcare provider. They will look for signs such as changes in the nipple or areola, including redness, scaling, or discharge.
2. **Imaging Tests**:
– **Mammography**: This X-ray of the breast can help identify underlying breast cancer or abnormalities, though it may not always reveal Paget’s disease itself.
– **Ultrasound**: This imaging test can provide additional information about breast tissue and help in distinguishing Paget’s disease from other conditions.
– **MRI**: In some cases, magnetic resonance imaging may be used to get a more detailed view of the breast tissue.
3. **Biopsy**: A definitive diagnosis is made through a biopsy, which involves taking a sample of tissue for microscopic examination. Several types of biopsies may be used:
– **Nipple Biopsy**: Involves removing a small portion of the nipple or areola tissue to examine for cancer cells.
– **Core Needle Biopsy**: A needle is used to remove a core of tissue from the affected area.
– **Excisional Biopsy**: Involves removing a larger area of tissue, sometimes including the entire nipple or areola, for examination.
4. **Histopathological Examination**: The biopsy sample is examined under a microscope by a pathologist to confirm the presence of Paget’s cells, which are characteristic of this disease. The pathologist will look for atypical cells in the skin of the nipple or areola.
5. **Additional Testing**: If Paget’s disease is diagnosed, further tests may be required to determine if there is an underlying breast cancer or to assess the extent of the disease. This could include additional imaging tests or biopsies of other areas of the breast.
Proper diagnosis is crucial for effective treatment planning, as Paget’s disease often indicates the presence of an underlying breast carcinoma that may need to be addressed in addition to the Paget’s disease itself.