A      Evidence based guidelines - the evidence base for mammography in suspected Pagets Disease of the nipple

Evidence Table J12

Suspected Pagets Disease of the Nipple

A

  

Clinical Problem

Suspected Paget’s disease of the nipple

A1

  

Ref No. in MBUR4 (if any)

J12

A2

  

Section in MBUR4

Breast disease

B

  

Search strategy: databases used; period; MeSH headings; other key words.

MEDLINE 1980-2001; Paget’s disease, breast mammography

C

  

Search results: no. found;

no. used.

32, used 3

D

  

Reference numbers of cited references in attached master list.

J12 1-3

E

  

Summarised results from each of the cited references

Ikeda et al (J12 1) found in a retrospective review of 58 patients that mammography showed findings in 50 % of patients with classical Paget’s, but 79% of patients without clinical findings. Ceccherini et al (J 12 2) retrospectively reviewed 27 patients with Paget’s disease and 60 patients with symptomatic DCIS without Paget’s. 44% of patients with Paget’s had a positive mammogram. Sawyer et al (J12 3) retrospectively reviewed 17 cases and showed mammographic abnormalities in 71%.

F

  

Statement (= the conclusion drawn from E)

Mammography is indicated to determine whether image guided biopsy is possible and confirm whether invasive disease is present.

G

  

Evidence level of F classified I - IV

3

H

  

Investigation

Mammography

I

  

Recommendation *

1 Indicated

J

  

Grade of Recommendation

A - C

C

K

  

Comment (if any) to go in booklet version of MBUR5

 Mammography will show an abnormality in 50% of women. It is helpful to determine the possibility of image-guided biopsy. When invasive disease is confirmed it will influence the surgical management of the axilla.

L

  

Any other comments on this problem (e.g. caveats; suggestions for research or systematic review; cost or opportunity cost; users' views.

Chris Flowers

Comments: mammography can be helpful in guiding biopsy

References: -

Ref ID Author; Year; Country; Grade (I-IV). Aims Patient population Study design* Results
J12 1 Ikeda; 1993; USA; III Correlation of radiology and pathology 58 consecutive patients with Pagets Disease of the Nipple. Retrospective Mammographic signs found in 50% women with classical Pagets. Also in 79% of women with no clinical findings
J12 2 Ceccherini: 1996; UK; III Pseudo study comparing mammography in Pagets with women with classical DCIS 27 patients with Paget’s disease and 60 patients with symptomatic DCIS without Paget’s Retrospective Mammographic signs found in 44% women.
J12 3 Sawyer; 1994; UK; III Retrospective review 17 consecutive cases of Pagets Retrospective Mammographic signs found in 71% women.
* e.g. RCT Comparison (pro/retro-spective)
Series (pro/retro-spective)
Audit