title: Paget's disease in the era of sentinel lymph node biopsy.
abstract: BACKGROUND
  Paget's disease of the breast is an uncommon cancer. "Breast cancer" management has evolved to include sentinel lymph node biopsy (SLNB). Our objective is to determine utilization of SLNB in the surgical algorithm of Paget's disease.
  
  
  METHODS
  After institutional review board approval, a database review of patients with Paget's disease was conducted. Patient demographics, tumor characteristics, treatment including use of SLNB, and survival were reviewed. Patient characteristics and outcomes were analyzed by using contingency table chi-square, pooled t tests, and log-rank tests for comparisons.
  
  
  RESULTS
  Fifty-four patients with Paget's disease were identified and divided into 2 cohorts (18 no SLNB and 36 SLNB). The mean age was 66 years for the no-SLNB group and 60 years for the SLNB group (P = .17). Paget's disease only was present in 33%, Paget's disease + DCIS in 41%, and Paget's disease + invasive cancer in 26%. The mean invasive tumor size was 1.62 cm in the no-SLNB group and 1.59 cm in the SLNB group (P = .96). For invasive disease, ER/PR status was similar, but Her2 was more likely to be overexpressed in SLNB (P = .04). Surgery choice ranged from "no surgery" to lumpectomy to mastectomy. Axillary staging was performed in 45 of 54 patients, with 11% in both cohorts having nodal disease. A sentinel lymph node was identified in 97% of patients. Five-year overall and disease-free survival was 100% in the no-SLNB group and 88% in the SLNB group (P = .97) and 76% in the no-SLNB group and 84% in the SLNB group (P = .88), respectively.
  
  
  CONCLUSIONS
  Paget's disease remains rare but should be treated similar to other "breast cancer." SLNB should be performed to evaluate the axilla when invasive disease is identified or a mastectomy is planned.
authors.affiliation: Department of Interdisciplinary Oncology, H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida, 12902 Magnolia Drive, MCC-BRPROG, Tampa, FL 33612-9497, USA. larongc@moffitt.usf.edu
authors.forename: Christine
authors.initials: C
authors.lastname: Laronga
authors.forename: Danielle
authors.initials: D
authors.lastname: Hasson
authors.forename: Susan
authors.initials: S
authors.lastname: Hoover
authors.forename: John
authors.initials: J
authors.lastname: Cox
authors.forename: Alan
authors.initials: A
authors.lastname: Cantor
authors.forename: Charles
authors.initials: C
authors.lastname: Cox
authors.forename: W Bradford
authors.initials: WB
authors.lastname: Carter
mesh_terms: D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003663:Decision Trees; D005260:Female; D006801:Humans; D008875:Middle Aged; D010144:Paget's Disease, Mammary / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D021701:Sentinel Lymph Node Biopsy; D015996:Survival Rate; D016896:Treatment Outcome