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CASE REPORT article

Front. Oncol.
Sec. Breast Cancer
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1497506
This article is part of the Research Topic Advancing Cancer Imaging Technologies: Bridging the Gap from Research to Clinical Practice View all 9 articles

Illustrating Associated Malignancies in Paget's Disease Using Contrast-Enhanced Mammography: Two Case Studies

Provisionally accepted
Luciano Mariano Luciano Mariano 1Luca Nicosia Luca Nicosia 1,2*Anna Bozzini Anna Bozzini 1Filippo Pesapane Filippo Pesapane 1Francesca Magnoni Francesca Magnoni 3Giovanni Mazzarol Giovanni Mazzarol 4Lorenza Meneghetti Lorenza Meneghetti 1Adriana Sorce Adriana Sorce 5Enrico Cassano Enrico Cassano 1
  • 1 Breast Imaging Division, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy, European Institute of Oncology (IEO), Milan, Lombardy, Italy
  • 2 Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, Varese, Italy,, University of Insubria, Varese, Italy
  • 3 Division of Breast Surgery, European Institute of Oncology, IRCCS, Milan, Italy., European Institute of Oncology (IEO), Milan, Lombardy, Italy
  • 4 Division of Pathology, European Institute of Oncology (IEO), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy, European Institute of Oncology (IEO), Milan, Lombardy, Italy
  • 5 Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy., University of Milan, Milan, Lombardy, Italy

The final, formatted version of the article will be published soon.

    Background: The following presentation explores the diagnostic potential of Contrast-Enhanced Mammography (CEM) in evaluating and managing Paget's Disease (PD) of the breast, particularly as an alternative or complementary tool to Magnetic Resonance Imaging (MRI) in cases where MRI is contraindicated or inconclusive. Clinical cases: Two clinical cases of PD diagnosed at our Breast Imaging Division between January and May 2024 were analysed using CEM. These cases involved imaging techniques, including Digital Mammography (DM), Breast Ultrasound (US), MRI and CEM, alongside histopathological confirmation through nipple-areolar complex (NAC) punch biopsies. CEM identified disease extensions and NAC involvement that was not evident in conventional imaging in both cases. CEM findings influenced surgical decisions, leading to total mastectomies with reconstruction instead of conservative approaches. The cases highlighted CEM's sensitivity and ability to delineate the disease extent comparable to MRI. Discussion and Conclusions: PD often presents diagnostic challenges due to frequent associations with underlying malignancies that are undetectable by standard imaging. While MRI is the gold standard, its limitations, such as costs, contraindications, and false positives, warrant alternative methods. CEM demonstrated utility in diagnosing and staging PD, offering benefits in patient acceptability, cost, and sensitivity comparable to MRI. CEM is a promising diagnostic and planning tool for PD management, especially in MRI-infeasible cases. More extensive multicentric studies will be needed to validate CEM's role in this context. CEM could enhance PD diagnostic workflows and treatment strategies, significantly impacting clinical outcomes.

    Keywords: Contrast enhanced mammography, CEM, breast cancer, breast imaging, Paget carcinoma

    Received: 17 Sep 2024; Accepted: 17 Dec 2024.

    Copyright: © 2024 Mariano, Nicosia, Bozzini, Pesapane, Magnoni, Mazzarol, Meneghetti, Sorce and Cassano. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Luca Nicosia, Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, Varese, Italy,, University of Insubria, Varese, Italy

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.