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Just-Sarobé M, Sánchez-Puigdollers A, Mohino-Farré N, Martin-Callizo C, Pujol-Montcusí JA, Pastor-Jane L. Ultrasonography for the Diagnosis and Follow-Up of Extramammary Paget Disease (EMPD): A Review. J Ultrasound Med 2024; 43:423-427. [PMID: 38054379 DOI: 10.1002/jum.16386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
Extramammary Paget disease (EMPD) is a rare skin tumor that manifests as poorly delimited lesions located mainly in genital area. Prognosis correlates with thickness and dermal invasion. The gold standard for diagnosis is the histopathological study of a biopsy. However, this technique is invasive and only shows a small area of the tumor. A good correlation has been reported between ultrasounds (US) and histopathologic finding. Moreover, a US examination has the advantages of wide availability, noninvasiveness, low cost, ease of use, and real-time scanning. We review the ultrasound signs described for this disease.
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Affiliation(s)
- Miquel Just-Sarobé
- Department of Dermatology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Nerea Mohino-Farré
- Department of Dermatology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | | | - Laia Pastor-Jane
- Department of Dermatology, Hospital Universitari Joan XXIII, Tarragona, Spain
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Shan DD, Wu NH, Wang Q, Ren WW, Zhu AQ, Wang LF, Liu YQ, Sun LP, Guo LH, Xu HX. Value of pseudopod sign on high-frequency ultrasound in predicting the pathological invasion of extramammary Paget's disease lesions. J Eur Acad Dermatol Venereol 2022; 36:1235-1245. [PMID: 35344636 DOI: 10.1111/jdv.18104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/04/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Vertical invasion of extramammary Paget's disease (EMPD) is associated with poor prognosis. The usual vertical invasion route is directly downward or along the skin appendages. High-frequency ultrasound (HFUS) can be used to measure the EMPD lesion thickness, and visualize the pseudopod extensions due to skin appendage involvement. It is a non-invasive method for evaluating the extent of vertical invasion in EMPD. OBJECTIVE To investigate the value of HFUS in predicting the extent of vertical invasion in EMPD. METHODS In this retrospective study, 85 patients with EMPD were divided into two groups based on the pathology: invasive EMPD (iEMPD) group (n = 13) and in situ EMPD group (n = 72). The clinical and HFUS features of both the groups were analyzed. The different types of pseudopodia morphology on HFUS were as follows: no pseudopodia, irregular bottom, small sphere, short strip, long strip, vase shape, and nodular convex. These were further stratified into low-risk and high-risk levels. RESULTS The clinical features were comparable between the two groups (P > .05). There were significant differences between the two groups in the HFUS features (lesion thickness, lesion shape, bottom shape, layer involvement, pseudopodia morphology, and color Doppler blood flow signal; all P < .05). The distribution of the pseudopodia morphology types in the in situ EMPD and iEMPD groups, was as follows: no pseudopodia, 30/72 and 0/13; irregular bottom, 5/72 and 0/13; small sphere, 5/72 and 0/13; short strip, 21/72 and 0/13; long strip, 8/72 and 3/13; vase shape, 3/72 and 3/13; and nodular convex, 0/72 and 7/13 (P < .05 for all). The sensitivity and specificity of high-risk pseudopodia in identifying iEMPD were 100% and 84.7%, respectively. CONCLUSIONS HFUS provides morphological information regarding EMPD lesions. Risk stratification for pseudopodia can help to distinguish between iEMPD and in situ EMPD lesions.
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Affiliation(s)
- D D Shan
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - N H Wu
- Department of Pathology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Q Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - W W Ren
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - A Q Zhu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - L F Wang
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - Y Q Liu
- Department of Pathology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - L P Sun
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - L H Guo
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
| | - H X Xu
- Department of Medical Ultrasound, Shanghai Skin Disease Hospital, Ultrasound Research and Education Institute, School of Medicine, Tongji University, Shanghai, China.,Center of Minimally Invasive Treatment for Tumor, Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China.,Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, China
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