IS IPSILATERAL MAMMOGRAPHY WORTHWHILE IN PAGETS-DISEASE OF THE BREAST

Aims: To identify the clinical value of pre-operative ipsilateral mamm ography in patients with Paget's disease of the breast. Method: The ma mmograms and histological data of 27 patients with Paget's disease and 60 patients with symptomatic DCIS without Paget's disease were review ed and compared. Results: Forty-four percent of patients with Paget's disease had normal mammograms, Mammography did not discriminate betwee n 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 la rge cell DCIS in non Paget's patients is normally visible mammographic ally, the large proportion of Paget's patients with normal mammography is difficult to explain, but could be due to the small size of the le sions, Comparison of the Paget's and non-Paget's groups showed that la rge cell solid disease was more common, small cell cribriform less com mon and normal mammography more common in the Paget's group. Given tha t mastectomy is the treatment of choice, the only clinical value of ip silateral mammography in our unit would be to allow image guided core biopsy of any detected mammographic abnormalities to determine the pre sence of invasive disease prior to surgery, thus indicating the need f or node sampling pre-operatively rather than as a delayed procedure. T his study also confirms that mammography is of little help in deciding if breast conserving surgery is appropriate for individual cases of P aget's disease of the nipple due to the insensitivity of mammography i n showing the site of disease.