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Inflammatory Breast Carcinoma
Jessica W. T. Leung, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Inflammatory breast cancer (IBC)
              • Definitions

                • Primary or true IBC: Locally advanced breast cancer (LABC) with rapid-onset (≤ 6 months) inflammatory skin changes, typically involving ≥ 1/3 of breast (T4d)
                  • Diffuse breast erythema
                  • Warmth, enlargement, pain, induration, edema
                  • Peau d'orange (skin resembling orange peel)
                  • Edema affecting ≥ 2/3 of breast
                • Secondary IBC: Appears after surgical treatment of noninflammatory breast cancer
                • Punch biopsy: Tumor emboli in dermal lymphatics; not required for or unique to diagnosis of IBC
                • Neoadjuvant chemotherapy (NAC): Chemotherapy prior to surgery
                • Adjuvant chemotherapy: Chemotherapy after surgery
                • Complete response (CR) to neoadjuvant chemotherapy (NAC): No clinical (cCR) or pathologic (pCR) disease
                • Partial response: Clinical ↓ in tumor size by > 50%

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Image-Guided Biopsy

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Gutierrez Barrera AM et al: BRCA mutations in women with inflammatory breast cancer. Cancer. 124(3):466-474, 2018
                                                2. Leong PW et al: Imaging features of inflammatory breast disorders: A pictorial essay. Korean J Radiol. 19(1):5-14, 2018
                                                3. DeSnyder SM et al: Prospective Feasibility Trial of Sentinel Lymph Node Biopsy in the Setting of Inflammatory Breast Cancer. Clin Breast Cancer. ePub, 2017
                                                4. Liu J et al: Chemotherapy response and survival of inflammatory breast cancer by hormone receptor- and HER2-defined molecular subtypes approximation: an analysis from the National Cancer Database. J Cancer Res Clin Oncol. 143(1):161-168, 2017
                                                5. Nakhlis F et al: The Impact of Residual Disease After Preoperative Systemic Therapy on Clinical Outcomes in Patients with Inflammatory Breast Cancer. Ann Surg Oncol. 24(9):2563-2569, 2017
                                                6. Rosso KJ et al: Improved Locoregional Control in a Contemporary Cohort of Nonmetastatic Inflammatory Breast Cancer Patients Undergoing Surgery. Ann Surg Oncol. 24(10):2981-2988, 2017
                                                7. Rosso KJ et al: In response to "outcomes of patients with inflammatory breast cancer treated by breast conserving surgery": the argument against breast conservation and sentinel lymph node biopsy in IBC. Breast Cancer Res Treat. 165(3):779-781, 2017
                                                8. van Uden DJP et al: Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Assessment of Inflammatory Breast Cancer Prior to and After Neoadjuvant Treatment. Breast Care (Basel). 12(4):224-229, 2017
                                                9. Wang X et al: EGFR signaling promotes inflammation and cancer stem-like activity in inflammatory breast cancer. Oncotarget. 8(40):67904-67917, 2017
                                                10. Abeywardhana DY et al: Review of ultrasound appearance in inflammatory breast cancer: A pictorial essay. J Med Imaging Radiat Oncol. 60(1):83-7, 2016
                                                11. Brzezinska M et al: Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery. Breast Cancer Res Treat. 160(3):387-391, 2016
                                                12. Loewen AH et al: Case Report: Hormone Receptor Positive, HER2/neu Negative Inflammatory Breast Cancer in a Male Patient. S D Med. 68(10):435-7, 439-40, 2015
                                                13. van Uden DJ et al: Inflammatory breast cancer: an overview. Crit Rev Oncol Hematol. 93(2):116-26, 2015
                                                14. Warren LE et al: Inflammatory Breast Cancer: Patterns of Failure and the Case for Aggressive Locoregional Management. Ann Surg Oncol. 22(8):2483-91, 2015
                                                15. Wecsler JS et al: Lymph node status in inflammatory breast cancer. Breast Cancer Res Treat. 151(1):113-20, 2015
                                                16. Akay CL et al: Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage IV inflammatory breast cancer. Cancer. 120(9):1319-28, 2014
                                                17. Dawood S et al: Survival of women with inflammatory breast cancer: a large population-based study. Ann Oncol. 25(6):1143-51, 2014
                                                18. Goldner B et al: Incidence of inflammatory breast cancer in women, 1992-2009, United States. Ann Surg Oncol. 21(4):1267-70, 2014
                                                19. Rueth NM et al: Underuse of trimodality treatment affects survival for patients with inflammatory breast cancer: an analysis of treatment and survival trends from the National Cancer Database. J Clin Oncol. 32(19):2018-24, 2014
                                                20. Yeh ED et al: What radiologists need to know about diagnosis and treatment of inflammatory breast cancer: a multidisciplinary approach. Radiographics. 33(7):2003-17, 2013
                                                21. Yamauchi H et al: Inflammatory breast cancer: what we know and what we need to learn. Oncologist. 17(7):891-9, 2012
                                                22. Dawood S et al: International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 22(3):515-23, 2011
                                                23. Le-Petross HT et al: MRI features of inflammatory breast cancer. AJR Am J Roentgenol. 197(4):W769-76, 2011
                                                24. Robertson FM et al: Inflammatory breast cancer: the disease, the biology, the treatment. CA Cancer J Clin. 60(6):351-75, 2010
                                                25. Carkaci S et al: Retrospective study of 18F-FDG PET/CT in the diagnosis of inflammatory breast cancer: preliminary data. J Nucl Med. 50(2):231-8, 2009
                                                26. Hidar S et al: Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg. 7(3):272-5, 2009
                                                27. Dawood S et al: Prognostic significance of HER-2 status in women with inflammatory breast cancer. Cancer. 112(9):1905-11, 2008
                                                28. Le-Petross CH et al: Evolving role of imaging modalities in inflammatory breast cancer. Semin Oncol. 35(1):51-63, 2008
                                                29. Renz DM et al: Magnetic resonance imaging of inflammatory breast carcinoma and acute mastitis. A comparative study. Eur Radiol. 18(11):2370-80, 2008
                                                30. Singletary SE et al: Defining the clinical diagnosis of inflammatory breast cancer. Semin Oncol. 35(1):7-10, 2008
                                                31. Yang WT et al: Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Res Treat. 109(3):417-26, 2008
                                                32. Thukral A et al: Inflammatory breast cancer: dynamic contrast-enhanced MR in patients receiving bevacizumab--initial experience. Radiology. 244(3):727-35, 2007
                                                33. Chow CK: Imaging in inflammatory breast carcinoma. Breast Dis. 22:45-54, 2005
                                                34. Hance KW et al: Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst. 97(13):966-75, 2005
                                                35. Merajver SD et al: Inflammatory breast cancer. In Harris JR et al: Diseases of the Breast. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins. 971-82, 2004
                                                36. Cristofanilli M et al: Update on the management of inflammatory breast cancer. Oncologist. 8(2):141-8, 2003
                                                37. Giordano SH et al: Inflammatory breast cancer: clinical progress and the main problems that must be addressed. Breast Cancer Res. 5(6):284-8, 2003
                                                38. Stearns V et al: Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol. 9(3):235-42, 2002
                                                39. Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Inflammatory breast cancer (IBC)
                                                            • Definitions

                                                              • Primary or true IBC: Locally advanced breast cancer (LABC) with rapid-onset (≤ 6 months) inflammatory skin changes, typically involving ≥ 1/3 of breast (T4d)
                                                                • Diffuse breast erythema
                                                                • Warmth, enlargement, pain, induration, edema
                                                                • Peau d'orange (skin resembling orange peel)
                                                                • Edema affecting ≥ 2/3 of breast
                                                              • Secondary IBC: Appears after surgical treatment of noninflammatory breast cancer
                                                              • Punch biopsy: Tumor emboli in dermal lymphatics; not required for or unique to diagnosis of IBC
                                                              • Neoadjuvant chemotherapy (NAC): Chemotherapy prior to surgery
                                                              • Adjuvant chemotherapy: Chemotherapy after surgery
                                                              • Complete response (CR) to neoadjuvant chemotherapy (NAC): No clinical (cCR) or pathologic (pCR) disease
                                                              • Partial response: Clinical ↓ in tumor size by > 50%

                                                            IMAGING

                                                            • General Features

                                                              • Mammographic Findings

                                                                • Ultrasonographic Findings

                                                                  • MR Findings

                                                                    • Nuclear Medicine Findings

                                                                      • Image-Guided Biopsy

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Gutierrez Barrera AM et al: BRCA mutations in women with inflammatory breast cancer. Cancer. 124(3):466-474, 2018
                                                                                              2. Leong PW et al: Imaging features of inflammatory breast disorders: A pictorial essay. Korean J Radiol. 19(1):5-14, 2018
                                                                                              3. DeSnyder SM et al: Prospective Feasibility Trial of Sentinel Lymph Node Biopsy in the Setting of Inflammatory Breast Cancer. Clin Breast Cancer. ePub, 2017
                                                                                              4. Liu J et al: Chemotherapy response and survival of inflammatory breast cancer by hormone receptor- and HER2-defined molecular subtypes approximation: an analysis from the National Cancer Database. J Cancer Res Clin Oncol. 143(1):161-168, 2017
                                                                                              5. Nakhlis F et al: The Impact of Residual Disease After Preoperative Systemic Therapy on Clinical Outcomes in Patients with Inflammatory Breast Cancer. Ann Surg Oncol. 24(9):2563-2569, 2017
                                                                                              6. Rosso KJ et al: Improved Locoregional Control in a Contemporary Cohort of Nonmetastatic Inflammatory Breast Cancer Patients Undergoing Surgery. Ann Surg Oncol. 24(10):2981-2988, 2017
                                                                                              7. Rosso KJ et al: In response to "outcomes of patients with inflammatory breast cancer treated by breast conserving surgery": the argument against breast conservation and sentinel lymph node biopsy in IBC. Breast Cancer Res Treat. 165(3):779-781, 2017
                                                                                              8. van Uden DJP et al: Dynamic Contrast-Enhanced Magnetic Resonance Imaging in the Assessment of Inflammatory Breast Cancer Prior to and After Neoadjuvant Treatment. Breast Care (Basel). 12(4):224-229, 2017
                                                                                              9. Wang X et al: EGFR signaling promotes inflammation and cancer stem-like activity in inflammatory breast cancer. Oncotarget. 8(40):67904-67917, 2017
                                                                                              10. Abeywardhana DY et al: Review of ultrasound appearance in inflammatory breast cancer: A pictorial essay. J Med Imaging Radiat Oncol. 60(1):83-7, 2016
                                                                                              11. Brzezinska M et al: Outcomes of patients with inflammatory breast cancer treated by breast-conserving surgery. Breast Cancer Res Treat. 160(3):387-391, 2016
                                                                                              12. Loewen AH et al: Case Report: Hormone Receptor Positive, HER2/neu Negative Inflammatory Breast Cancer in a Male Patient. S D Med. 68(10):435-7, 439-40, 2015
                                                                                              13. van Uden DJ et al: Inflammatory breast cancer: an overview. Crit Rev Oncol Hematol. 93(2):116-26, 2015
                                                                                              14. Warren LE et al: Inflammatory Breast Cancer: Patterns of Failure and the Case for Aggressive Locoregional Management. Ann Surg Oncol. 22(8):2483-91, 2015
                                                                                              15. Wecsler JS et al: Lymph node status in inflammatory breast cancer. Breast Cancer Res Treat. 151(1):113-20, 2015
                                                                                              16. Akay CL et al: Primary tumor resection as a component of multimodality treatment may improve local control and survival in patients with stage IV inflammatory breast cancer. Cancer. 120(9):1319-28, 2014
                                                                                              17. Dawood S et al: Survival of women with inflammatory breast cancer: a large population-based study. Ann Oncol. 25(6):1143-51, 2014
                                                                                              18. Goldner B et al: Incidence of inflammatory breast cancer in women, 1992-2009, United States. Ann Surg Oncol. 21(4):1267-70, 2014
                                                                                              19. Rueth NM et al: Underuse of trimodality treatment affects survival for patients with inflammatory breast cancer: an analysis of treatment and survival trends from the National Cancer Database. J Clin Oncol. 32(19):2018-24, 2014
                                                                                              20. Yeh ED et al: What radiologists need to know about diagnosis and treatment of inflammatory breast cancer: a multidisciplinary approach. Radiographics. 33(7):2003-17, 2013
                                                                                              21. Yamauchi H et al: Inflammatory breast cancer: what we know and what we need to learn. Oncologist. 17(7):891-9, 2012
                                                                                              22. Dawood S et al: International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol. 22(3):515-23, 2011
                                                                                              23. Le-Petross HT et al: MRI features of inflammatory breast cancer. AJR Am J Roentgenol. 197(4):W769-76, 2011
                                                                                              24. Robertson FM et al: Inflammatory breast cancer: the disease, the biology, the treatment. CA Cancer J Clin. 60(6):351-75, 2010
                                                                                              25. Carkaci S et al: Retrospective study of 18F-FDG PET/CT in the diagnosis of inflammatory breast cancer: preliminary data. J Nucl Med. 50(2):231-8, 2009
                                                                                              26. Hidar S et al: Sentinel lymph node biopsy after neoadjuvant chemotherapy in inflammatory breast cancer. Int J Surg. 7(3):272-5, 2009
                                                                                              27. Dawood S et al: Prognostic significance of HER-2 status in women with inflammatory breast cancer. Cancer. 112(9):1905-11, 2008
                                                                                              28. Le-Petross CH et al: Evolving role of imaging modalities in inflammatory breast cancer. Semin Oncol. 35(1):51-63, 2008
                                                                                              29. Renz DM et al: Magnetic resonance imaging of inflammatory breast carcinoma and acute mastitis. A comparative study. Eur Radiol. 18(11):2370-80, 2008
                                                                                              30. Singletary SE et al: Defining the clinical diagnosis of inflammatory breast cancer. Semin Oncol. 35(1):7-10, 2008
                                                                                              31. Yang WT et al: Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Res Treat. 109(3):417-26, 2008
                                                                                              32. Thukral A et al: Inflammatory breast cancer: dynamic contrast-enhanced MR in patients receiving bevacizumab--initial experience. Radiology. 244(3):727-35, 2007
                                                                                              33. Chow CK: Imaging in inflammatory breast carcinoma. Breast Dis. 22:45-54, 2005
                                                                                              34. Hance KW et al: Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst. 97(13):966-75, 2005
                                                                                              35. Merajver SD et al: Inflammatory breast cancer. In Harris JR et al: Diseases of the Breast. 3rd ed. Philadelphia: Lippincott, Williams & Wilkins. 971-82, 2004
                                                                                              36. Cristofanilli M et al: Update on the management of inflammatory breast cancer. Oncologist. 8(2):141-8, 2003
                                                                                              37. Giordano SH et al: Inflammatory breast cancer: clinical progress and the main problems that must be addressed. Breast Cancer Res. 5(6):284-8, 2003
                                                                                              38. Stearns V et al: Sentinel lymphadenectomy after neoadjuvant chemotherapy for breast cancer may reliably represent the axilla except for inflammatory breast cancer. Ann Surg Oncol. 9(3):235-42, 2002
                                                                                              39. Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000