Is central lumpectomy always required for Paget's disease of the breast?

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...

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.