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The Role of Sentinel Lymph Node Biopsy in Paget’s Disease of the Breast

¹ Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, Magee–Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
² Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
³ Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, MRI-1026, New York, NY 10021, USA
⁴ Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

Correspondence: Address correspondence and reprint requests to: M.L. Gemignani; E-mail: partridm{at}mskcc.org

Background: Sentinel lymph node (SLN) biopsy has become a standard of care for axillary lymph node staging in breast cancer and appears suitable for virtually all patients with clinically node-negative (cN0) invasive disease. However, its role in Paget’s disease of the breast, a condition in which invasion may or may not be present, remains undefined.

Methods: Among 7,083 consecutive SLN biopsy procedures, we retrospectively identified 39 patients with Paget’s disease of the breast. Nineteen patients had no associated clinical/ radiographic features ("Paget’s only"), and 20 patients had associated clinical/radiographic findings ("Paget’s with findings").

Results: The mean ages for the Paget’s alone and with findings groups were 63.6 and 49.6 years, respectively. The use of breast conservation therapy was 32% in the Paget’s alone group and 10% in the Paget’s with findings group. Invasive carcinoma was found in 27% of patients in the Paget’s alone group and 55% of patients in the Paget’s with findings group. The success rate of SLN biopsy was 98%, and the mean number of SLNs removed was 3 in both groups. In the entire cohort of Paget’s disease, 28% (11/39) of the patients had positive SLNs (11%, Paget’s alone; 45%, Paget’s with findings).

Conclusion: In our "Paget’s only" cohort, invasive cancer was found in 27% of cases and positive SLNs in 11%. SLN biopsy should be considered in all patients with Paget’s disease of the breast, whether associated clinical/radiographic findings are present.