What Radiologists Need to Know about Diagnosis and Treatment of Inflammatory Breast Cancer: A Multidisciplinary Approach

Abstract

Inflammatory breast cancer (IBC) is a rare breast cancer with a highly virulent course and low 5-year survival rate. Trimodality treatment that includes preoperative chemotherapy, mastectomy, and radiation therapy is the therapeutic mainstay and has been shown to improve prognosis. Proper diagnosis and staging of IBC is critical to treatment planning and requires a multidisciplinary approach that includes imaging. Patients with IBC typically present with rapid onset of breast erythema, edema, and peau d'orange. Both tissue diagnosis of malignancy and clinical findings of inflammatory disease are required to confirm diagnosis of IBC. Imaging is used to identify a biopsy target; direct biopsy; stage IBC; differentiate curable from incurable (stage IV) disease; and help plan chemotherapy, surgical management, and radiation therapy. Comparison of baseline and posttreatment images helps confirm and quantitate disease response. When imaging is used early in the course of therapy to noninvasively predict treatment response, optimal tailored strategies for management of IBC can be implemented. Imaging is vital to diagnosis and treatment planning for patients with IBC, and radiologists are an integral part of the multidisciplinary patient care team.

The use of ultrasonography and digital mammography in women under 40 years with symptomatic breast cancer: a 7-year Irish experience

“…While not a feature of this study, inflammatory breast cancer (IBC) is a separate and rare clinical entity manifesting in a younger population [20] and is worthy of mention. It is characterised by diffuse erthyma and oedema of the breast [21].…”

“…While the diagnosis of this cancer subtype is a clinical and histological one, imaging plays an important complimentary diagnostic role and is used for the identification of a biopsy target [22]. The typical radiological appearances of IBC are skin thickening, trabecular coarsening and oedema [20]. These appearances, in the absence of an identifiable mass lesion can resemble mastitis.…”

Unilateral breast edema due to subclavian vein compression

“…Histologically, there is an invasion and obstruction of the lymphatics of the dermis and capillaries and of subepidermal venules, resulting in mammographic findings of edema and cutaneous retraction. Malignant nodule and calcifications may be present; axillary lymph node disease is a common occurrence 1,[3][4][5] . Ultrasonography may evidence an irregular hypoechoic nodule with speculated or indistinct margins and posterior acoustic shadow; the nodule may be obscured in the mammography due to the increased breast density, in addition to the possibility of showing an invasion of pectoral muscles and lymph node involvement 3 .…”

The Role of Secondary Metabolites on Gynecologic Cancer Therapy: Some Pathways and Mechanisms

“…The main purpose of treatment is to improve the quality of life and prolong survival. 26,27 Inflammatory response in cancer Several inflammatory mediators are responsible for the formation of cancer. Various anticancer drugs exhibit action directly on pro-inflammatory cytokines such as interleukin (IL)-6 or tumor necrosis factor (TNF)-α.…”