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NCCN Guidelines Index
Breast Cancer Table of Contents
Discussion
Version2.2015, 03/11/2015© National Comprehensive Cancer Network, Inc. 2015,All rights reserved.The NCCN Guidelines
®
and this illustration may not be reproduced in any form without the express written permission of NCCN
®
.
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.
PAGET-2
NCCN Guidelines Version 2.2015
Paget’s Disease
b
To assess the extent of disease or to confirm additional disease, consider MRI.
See Principles of Dedicated Breast MRI Testing (BINV-B)
.
c
Mastectomy is always an option with any manifestation of Paget’s disease (
See Discussion section
).
WORKUP
TREATMENT
Examination
or imaging
positive for
breast lesion
Examination
and imaging
negative for
breast lesion
Core biopsy of
breast lesion and
full-thickness skin
biopsy of involved
NAC
Full-thickness
skin biopsy of
involved NAC
Breast and NAC
biopsy negative
Clinical follow-up
Re-biopsy if not healing
Breast DCIS
b
and NAC Paget’s
Breast invasive cancer
and NAC Paget’s
b
Breast negative for
cancer and positive
NAC Paget’s
b
NAC biopsy positive
for Paget’s
b
NAC biopsy
negative for Paget’s
See NCCN Guidelines for Noninvasive Breast
Cancer for DCIS (DCIS-1)
See NCCN Guidelines for Invasive Breast
Cancer (BINV-1)
Clinical follow-up
Re-biopsy if not healing
Appropriate
systemic
adjuvant therapy
as clinically
indicated
See NCCN
Guidelines for
DCIS or Invasive
Breast Cancer
Consider
MRI and
tissue
sampling
Central lumpectomy including NAC
with whole breast radiation therapy
or
Total mastectomy
c
± sentinel node
biopsy with or without breast
reconstruction
or
Central lumpectomy including NAC
± sentinel node biopsy without
radiation therapy (category 2B)