An Integrative review of imaging approaches and clinical management in Paget's disease of the breast.

Paget disease of the breast represents a rare variant of breast cancer, primarily affecting the epidermis of the nipple-areola complex. It typically manifests as unilateral eczema or ulceration of the nipple. In over 90% of instances, it is concomitant with an underlying breast malignancy, such as ductal carcinoma in situ, invasive carcinoma, or both. The diagnosis is predominantly clinical, and is corroborated through histopathological examination. Imaging is pivotal in identifying any associated malignancy. Although mammography may yield normal results in up to 50% of cases, breast MRI provides superior sensitivity, particularly in patients lacking palpable abnormalities, by delineating the full extent of the disease. This review examines the etio-pathogenesis, clinical manifestations, and imaging characteristics across ultrasound, mammography, and MRI, and proposes an algorithmic imaging approach for the diagnosis and subsequent management of Paget disease of the breast.