Which of the following treatments should never be recommended to a patient with purely intraductal carcinoma?

C. Incisional biopsy with an involved margin, followed by radiation.

DISCUSSION: The treatment approach to intraductal carcinoma depends on the extent of the disease, its multifocality, and the involvement of the surgical margin. For extensive disease, modified radical mastectomy is appropriate, particularly if there is a great likelihood of occult invasive disease, making axillary dissection logical. For small foci of disease excised to clear surgical margins, observation is an acceptable recommendation to a well-informed patient. Several noncontrolled reviews and the National Surgical Adjuvant Breast and Bowel Project (NSABP) trial for intraductal disease would indicate a greater chance of ipsilateral breast recurrence for lumpectomy only; however, the magnitude of the risk is small, and survival is excellent and unaffected. The only mode of treatment that cannot be recommended for routine management is leaving residual disease in the breast and treating only with radiation.