Clinical Analysis Of48Cases Of Paget’s Disease Of The Breast And Traditional Chinese Medicine’s Understanding

Objective: The purpose of this study is to discuss the clinical manifestations,diagnostic methods, surgical options and prognosis of Paget’s disease of the breast byanalyzing clinical materials, and further summarize the understanding of TraditioalChinese Medicine to it as well as adjuvent therapy.Method: Retrospectively analyze the clinical data (including age, clinicalmanifestation, auxiliary examination, surgical option, postoperative pathology andimmunohistochemistry etc.) of48patients who were diagnosed with Paget’s disease ofthe breast by postoperative pathologic results in Dalian Medical University Hospitalfrom November2002to December2013. In combination with pertinent literature data,make systematic analysis to relapse of different surgical methods and factors affectingprognosis. Apply theories of Traditional Chinese Medicine in pathogenesis，dialecticaltype and adjuvant therapy of breast cancer to research the Paget’s disease of the breast.Result: Most of the48cases occurred in menopause, with a duration from1weekto60months. The clinical manifestation of Paget’s disease of the breast is similar to thenipple eczema. Some patients were not improved after a long-term use of steroids, and14patients were once misdiagnosed as benign lesion.16of the48cases were examined byUstrasonography,9diagnosed with underlying carcinoma.11cases by Mammography,6withlesions in nipple-areola complex and3of9cases with nonpalpable breast carcinoma.4cases by MRI examination, all with lesions in nipple-areola complex and2of3caseswith nonpalpable breast carcinoma.26cases in this group underwent biopsy and18were diagnosed, including7out of14cases who were ordered cell image insepction and11out of12cases who were ordered excision biopsy. Postoperative pathology: in all of48patients,11cases(22.9%) were simple Paget’s disease of the breast,37cases(77.1%)were associated with underlying carcinoma,19cases(39.6%) with ductal carcinoma insitu (DCIS),17cases(35.42%) with invasive ductal carcinoma (IDC) and1case(2.1%)with simple breast cancer;14cases with multi-central lesions（29.2%），5cases withlymph node status（12.5%）。The cases with mass detected11cases with DCIS（84.6%）and2cases with IDC（15.4%） by pathology. The cases without mass detected6caseswith DCIS （26.1%） and17cases with IDC （73.9%） by pathology.Immunohistochemistry: ER positive rate was21.1%: PR positive rate was15.8%,C-erbB-2positive rate was100%. In the48cases,8accepted breast-conserving surgery,2patients relapsed with a recurrence rate of25%. The rest40cases accepted totalmastectomy,9of which relapsed wth a recurrence rate of25%. The5-year survival forall cases was85%, for cases with and without invasive breast cancer were68.15%and94.44%respecively(p<0.05), and for cases with and without mammary tumors were78.57%and100%respectively(p<0.05).Conclusion: The Paget’s disease of the breast is more common amongpostmenopausal women, with features of long disease course and high misdiagnosis rate.The most effecitve diagnostic method at the early stage is incisional biopsy. MRI isthe most effect method to assess the patient with Paget’s disease of the breast beforesurgery. Patients with tumor, invasive ductal carcinoma, lymph node metastasis usuallyhave poor prognosis. The treatment is operation-based. It should be cautious whenchoosing breast-conserving surgery, and sentinel lymph node biopsy should be attachedimportance to. The Traditional Chinese Medicine understanding has been matured andits adjuvant therapy is very important.