In Paget's disease of the nipple without a palpable breast mass and with a negative mammogram, the most appropriate next investigation is:

• A Punch biopsy of the nipple areolar complex only
• B Fine needle aspiration cytology of the nipple
• C Ultrasound-guided core biopsy of subareolar region
• D MRI of the breast ✓

Explanation

Paget's disease of the nipple is associated with an underlying in-situ or invasive carcinoma in the vast majority of cases. When clinical examination is negative and mammogram is unrevealing, breast MRI is the recommended next investigation as it detects occult underlying ductal carcinoma in situ or invasive cancer not visible on conventional imaging. Punch biopsy of the nipple is used to confirm Paget's disease histologically but does not evaluate underlying parenchymal disease. FNAC and ultrasound core biopsy are inadequate as first-line evaluation in this scenario.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.