Sonographic visualization of nipple blood flow can help differentiate Paget disease from benign eczematous nipple lesions

<div><p>Purpose</p><p>Paget disease of the breast is a rare cancer that originates from the nipple–areolar complex. It is often overlooked and misdiagnosed as benign chronic eczema of the nipple. We aimed to retrospectively verify whether blood flow analysis using Doppler sonography was useful for detecting the presence of Paget disease.</p><p>Methods</p><p>In this retrospective study, 12 patients with pathologically proven unilateral nipple eczematous lesions (seven with Paget disease and five with simple dermatitis) were included. Nipple blood flow signal was observed using Doppler sonography, and the detected blood flow signals were quantified using digitally recorded images. Quantified blood flow ratio and pathologically examined capillary density were evaluated between affected and unaffected nipples. Findings of mammography, grayscale sonography, and contrast-enhanced magnetic resonance imaging (CE-MRI) were reviewed.</p><p>Results</p><p>In patients with Paget disease, Doppler effects in the affected nipple were more clearly visible than those in the unaffected nipple. These effects were sufficiently visible to identify Paget disease. No obvious effects were observed in the affected and unaffected nipples of simple dermatitis. The quantified blood flow ratio and pathologically examined capillary density were significantly higher for the Paget lesion than those for the non-Paget lesion. The sensitivity of CE-MRI and Doppler sonography was markedly correlated, revealing blood flow changes in the nipple lesions of Paget disease.</p><p>Conclusion</p><p>Doppler sonography visualized the proliferation of blood vessels in Paget lesions. The visualization of increased nipple blood flow using Doppler sonography is a simple and low-cost method that provides useful data for identifying Paget disease during routine medical care.</p></div

Sonographic visualization of nipple blood flow can help differentiate Paget disease from benign eczematous nipple lesions - Fig 3

<p>(a) Visualized hypervascularity of the affected nipple with Paget disease (Case 1). (b) Unchanging blood flow signals of the affected nipple with simple dermatitis (Case 8).</p

Comparison of nipple blood flow ratios between the affected and unaffected nipples with each condition.

<p>Comparison of nipple blood flow ratios between the affected and unaffected nipples with each condition.</p

Histopathological examinations of capillary proliferation of the nipple–areolar region by hematoxylin and eosin staining.

<p>(a) Normal skin control with Paget disease (×40). (b) Normal skin control with Paget disease (×100). (c) Paget lesion at ×40). (d) Paget lesion at ×100). (e) Dermatitis at ×40). (f) Dermatitis at ×100). Bar, 50 μm (b, d, and f).</p

Clinical and pathological findings of the 12 patients.

<p>Clinical and pathological findings of the 12 patients.</p

The area selection and calculation using Photoshop.

<p>(a) Using the “Magnetic Lasso” Tool, the nipple area was selected and calculated by counting the number of pixels enclosed in the area. (b) Using the “Similar” function, the whole blood flow signals within the traced nipple was defined and calculated by counting the number of pixels.</p

An 81-year-old woman with Paget disease (Case 7).

<p>(a) Scaling and erosion of the affected right nipple. (b) Blood flow signals inside the affected nipple as observed using Doppler sonography. (c) Nipple enhancement by CE-MRI. (d) Histopathological examinations with hematoxylin and eosin staining reveal Paget cells within the epidermis and capillary proliferation within the dermis (×100).</p

The findings of mammography, grayscale sonography, and CE-MRI for seven patients with Paget disease.

<p>The findings of mammography, grayscale sonography, and CE-MRI for seven patients with Paget disease.</p