optimal imaging

I have been diagnosed with Paget's disease of the nipple. I have no palpable masses in my breast nor any that show on mammogram.  What is the best imaging technique to determine whether I have deeper lesions?  High resolution ultrasound? MRI? PET scan? other?  What about imaging  to reveal metastases?  Thank you.

[CCF-RN,MSN-JS]

Dear Dotking, Traditional treatment of Paget's disease of the nipple had been mastectomy.  There have been more attempts to use breast conservation treatment (removal of the nipple and areola and some of the tissue beneath,leaving most of the breast tissue), and in the evaluation of who would be a candidate for this procedure detailed mammographic evaluation (including magnification views of the area beneath the areola), and pathological assessment making sure that the surgical margins are free of cancer are essential components to this.

The use of other imaging would not be able to replace the analysis of the tissue under the microscope.  Doing these imaging techniques may be different ways of looking at the breast tissue but unless the abnormality became large enough to be detected, even with something like PET scan that looks for increased metabolism which could signal overactive cells, they aren't detecting microscopic changes.

If no palpable mass is felt, nothing is seen on the detailed mammogram then surgery to remove diseased area would be done.  Based on the findings of the surgery (tumor margins, any invasive component) would determine what further treatment would be recommended.

Scanning for metastasis if there was concern of spread of disease beyond the breast.  This may include ct scans of chest, abdomen,pelvis, and bone scan.  MRI are best used for detailed focus on an area of the body.  PET scans are relatively new and the benefit of their use in staging of breast cancer has not been fully determined.