Feasibility of breast conserving surgery for Paget’s disease

IntroductionThe standard treatment for Paget’s disease of the breast is mastectomy. Since it is frequently associated with underlying carcinoma, many surgeons are reluctant to choose breast conserving surgery for Paget’s disease.Patients and methodsWe retrospectively analyzed a series of 59 patients with Paget’s disease who had undergone mastectomy at the National Cancer Center Hospital between 1963 and 2009.ResultsIn 55 of 59 cases (93%) there was underlying carcinoma in the ipsilateral breast. Clinically, 27 (46%) patients had no evidence of other tumors, but 23 (85%) had underlying histopathologically confirmed carcinoma. Based on the data from this subset, cone excision with a 3-cm radius and a 4-cm radius could completely resect any underlying malignancy in 74% and 85% of patients, respectively.ConclusionAs Paget’s disease is frequently accompanied by underlying intraductal and/or invasive carcinoma, patients should be carefully selected for breast conserving surgery.