Current surgical approach to Paget's disease.

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Background:

• Paget's disease of the breast accounts for 1-3% of all breast malignancies.
• Standard surgical therapy for this condition remains challenging due to its rarity.
• Identifying preoperative factors for successful breast conservation is crucial.

Purpose of the Study:

• To identify preoperative factors that predict successful breast conservation in patients with Paget's disease of the breast.
• To evaluate the efficacy of breast conservation versus mastectomy in this patient population.

Main Methods:

• Retrospective review of 51 patients with Paget's disease treated between October 1998 and January 2010.
• Analysis of clinical presentation, preoperative imaging (mammogram, MRI), and pathological tumor characteristics.
• Assessment of surgical, radiation, and adjuvant therapies received.

Main Results:

• 37% of patients underwent breast conservation, while 63% had a mastectomy.
• Patients presenting with a palpable mass (12 cases) all required mastectomy.
• Mammograms identified extensive abnormalities in 22 patients, necessitating mastectomy. MRI aided surgical planning in 52% of cases.
• No local/regional recurrence was observed at a median follow-up of 29 months.

Conclusions:

• Paget's disease of the breast is amenable to breast conservation in carefully selected patients.
• Successful breast conservation is associated with the absence of a palpable finding, a benign mammogram, and normal MRI results.
• This suggests that meticulous preoperative assessment can guide surgical decisions for optimal patient outcomes.