Inflammatory breast cancer (IBC) is a rare type of aggressive breast cancer. The cancer spreads quickly to other parts of the body through the lymphatic system and blood circulation.1 Most of the inflammatory breast cancers are caused by invasive ductal carcinomas. Cancer cells originate from the cells of the mammary ducts, which produce milk.2 These cancer cells spread beyond the mammary ducts into surrounding lymphatic vessels and lymph nodes. The tumor cells mass eventually blocks the lymphatic vessels that lies within the surrounding skin, subcutaneous tissue and breast. The blocking of lymph vessels causes stoppage of lymph flow and swelling of lymphatic vessels. The stagnation of lymphatic fluid follows oozing of lymphatic fluid into surrounding subcutaneous and breast tissue. The stagnant lymph fluid and adjacent soft tissue gets infected and become severely inflamed. The inflammation of lymphatic vessels and surrounding tissue of breast causes severe pain as well as breast become red and swollen. Such condition is known as inflammatory breast cancer.3 Some of the cancer cells gets deposited in distant organs that results in metastasis.
10 Tests to Diagnose Inflammatory Breast Cancer
Diagnosis can be made through detail history and physical examination of the breast and lymph nodes. Most cases are further investigated to confirm the clinical diagnosis. Following tests are needed to confirm the diagnosis.4
- Diagnostic Mammography: Mammogram is an x-ray test of the breast. It shows most of the benign and malignant breast growth. The small benign breast tumor is also known as breast lump.
- Ultrasound Scan: Ultrasound for inflammatory breast cancer can differentiate the diffuse mass from fluid-filled cysts or abscess. Non-cancerous breast inflammation may cause breast abscess and ultrasound helps to locate fluid collection caused by abscess.
- Magnetic Resonance Imaging (MRI): MRI studies are performed to evaluate solid tumors or lumps of the breast tissue that is found during routine or annual examination. Similarly, a MRI examination is also requested in a patient suffering from inflammatory breast condition to rule out breast mass or a breast lump. Absence of lump or breast mass in a patient suffering from an inflammatory skin condition of the breast, suggests the presence of skin or subcutaneous inflammatory condition caused by either infection or inflammatory breast cancer. MRI test is often performed with injection of contrast that differentiates abnormal tissue.
- Fine Needle Aspiration Biopsy (FNA): This is the least invasive test to obtain a biopsy. Inflammatory breast cancer is better diagnosed following biopsy and histological examination of inflamed breast tissue. The biopsy is performed to remove breast tissue. The breast tissue is removed using needle aspiration or skin incision. The needle is placed within inflamed breast tissue, and part of the inflamed breast tissue aspirated with negative pressure. MRI or ultrasound guides the accurate needle placement within the inflamed breast tissue. The tissue sample is then treated with various stains and staining agents. The tissue is examined under the magnified microscope. The false-negative results may occur if the tissue sample does not include diseased breast tissue.
- Core Needle Biopsy: Procedure involves insertion of larger diameter needle within breast tissue. A larger needle is used to remove a large piece of tissue from the lump. A vacuum-assisted biopsy can remove several samples of tissue. In inflammatory breast cancer, there might not be a single primary tumor; therefore, several tissue samples from different places are needed to diagnose disease. Local anesthesia is given to numb the skin, subcutaneous tissue and underlying breast prior to insertion of large diameter needle.
- Skin Punch Biopsy: Skin punch biopsy is performed to remove full thickness skin specimens. Procedure is performed by surgeon. The circular blade passed through the skin and subcutaneous tissue. The 3 to 4 mm cylindrical core of tissue removed by blunt or sharp dissection using tiny knife. Tissue sample is examined for presence of cancer cells.
- Surgical Biopsy: The cancer is spread through the lymphatics resulting in lymphatic and surrounding tissue inflammatory reaction. The targeted biopsy is performed on the diffuse skin thickening and enhancement. The histological study confirms the diagnosis.5 Mammogram, ultrasound scan, or MRI can be used to direct the needle to the smaller inflammatory mass while performing a needle biopsy. This is an excellent way to take a needle biopsy for inflammatory breast cancer because imaging can show the best place to take the biopsy.
- CT scan- CT scan is routinely used to diagnose metastatic lymph node as well as distant spread of cancer.
- PET Scan- PET scan is also known as positron emission tomography. Radioactive substance is injected in the vein. The scan looks for deposits of radioactive substance in bones and soft tissues. The scan helps to identify cancer spread that is missed by CT Scan and MRI.
- Bone scan- Bone scan is nuclear imaging of entire skeletal system. The scan shows the metastatic tumor growth anywhere in skeletal system.
Inflammatory breast cancer (IBC) is a rare type of breast cancer. Diagnosis can be made through symptoms and physical examination of the breast and lymph nodes. Tests are needed to confirm the diagnosis. The imaging tests are MRI, mammogram, and ultrasound scan. MRI gives more information about the spread, size of the tumor, and if there is cancer in the other breast. The biopsy is the definitive test to diagnose disease; core biopsy is the best technique to get the biopsy for inflammatory breast cancer.
Skin punch biopsy also can be done to identify cancer cells in the skin if a lump is not felt image-guided biopsy can be done.
- Inflammatory breast cancer: the disease, the biology, the treatment.Robertson FM1, Bondy M, Yang W, Yamauchi H, Wiggins S, Kamrudin S, Krishnamurthy S, Le-Petross H, Bidaut L, Player AN, Barsky SH, Woodward WA, Buchholz T, Lucci A, Ueno NT, Cristofanilli M., CA Cancer J Clin. 2010 Nov-Dec;60(6):351-75.
- Epidemiology of Inflammatory Breast Cancer (IBC)1 William F. Anderson,a,* Catherine Schairer,a Bingshu E. Chen,a Kenneth W. Hance,a and Paul H. Levineb, Breast Dis. 2005; 22: 9–23.
- Inflammatory Breast Cancer: A Literature Review Fouzia Mamouch,a,b,c Narjiss Berrada,b Zineb Aoullay,a,b Basma El Khanoussi,b and Hassan Errihania,b, , World J Oncol. 2018 Nov; 9(5-6): 129–135.
- Inflammatory Breast Cancer: What We Know and What We Need to Learn Hideko Yamauchi,a Wendy A. Woodward,b,h Vicente Valero,c,h Ricardo H. Alvarez,c,h Anthony Lucci,d,h Thomas A. Buchholz,b,h Takayuki Iwamoto,c Savitri Krishnamurthy,e,h Wei Yang,f,h James M. Reuben,g,h Gabriel N. Hortobágyi,c,h and Naoto T. Ueno c,h, Oncologist. 2012 Jul; 17(7): 891–899.