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Breast Cancer • Radiation Oncology
Is central lumpectomy always required for Paget's disease of the breast?
The NCCN Breast guidelines specify that for a patient with Paget's disease of the NAC with a positive full-thickness skin biopsy of involved NAC but a negative core biopsy of a breast lesion, standard of care treatment involves a central lumpectomy with WBRT (or total mastectomy).
If, however, a patient does indeed have biopsy-proven DCIS and/or invasive disease, do they also require a central lumpectomy? The NCCN guidelines simply refer to standard DCIS or invasive treatment in this instance.
Answer from: Radiation Oncologist at Academic Institution
Radiation without surgery for patients with Paget's disease was abandoned decades ago, but perhaps unfairly. Several groups in the pioneering era of breast-conserving therapy tried this approach. Local failure rates with whole-breast irradiation with or without a boost in patients with disease limit...
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Answer from: Radiation Oncologist at Community Practice
In the EORTC series, about 7% had no DCIS or IDC disease in central lumpectomy specimen.Bijker et al., PMID 11169928 Unless modern imaging can identify this small subset with certainty, central lumpectomy is routinely done at our place with indications for RT based on risk factors.