Imaging in Paget disease of breast

Paget disease is a rare malignancy that involves the nipple and areola and infiltrates the skin of the nipple by adenocarcinoma. It is essential to diagnose it correctly, as more than 90% of Paget disease cases are associated with underlying breast cancer. It is usually associated with ductal carcinoma in situ (DCIS) involving the lactiferous ducts at the nipple-areolar complex. However, it may be associated with DCIS or invasive breast carcinoma in the breast parenchyma at distant locations. Mammography may not detect Paget disease in approximately 50% of cases. A multimodality imaging approach is suggested to evaluate the nipple-areolar complex and underlying breast with breast ultrasound and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in negative mammograms. Radiology investigations are helpful in appropriate surgical treatment and monitoring. This article describes the spectrum of imaging findings on various radiology modalities and characteristic clinical and pathological features of Paget’s disease.