By Dr. Kathleen Ruddy

Inflammatory breast cancer (IBC) is an uncommon type of breast cancer found in approximately 5% of patients in the United States. It is the most aggressive type of breast cancer, associated with a high recurrence rate and low overall survival. The diagnosis of IBC is made on clinical grounds. Rapid onset of symptoms (breast redness, itching, swelling, warmth, and pain) and rapid progression of disease are its hallmarks. Because the symptoms of IBC are similar to those seen in women with breast infection (mastitis), patients are often treated for weeks or months with antibiotics before they are referred to a breast specialist. A tissue biopsy documenting the presence of invasive breast cancer in the setting of the classic presenting symptoms confirms the diagnosis.

What is the role of MRI in evaluating patients with IBC?

MRI is used to diagnose and stage patients with IBC and is used to monitor response to chemotherapy once treatment has begun.

How does MRI compare to mammography and ultrasound in evaluating patients with IBC?

MRI is superior to both mammography and breast ultrasound in diagnosing, staging, and assessing response to treatment in patients diagnosed with IBC.

DID YOU KNOW?

In two recent studies of patients with IBC, the most common MRI findings were multiple, suspicious masses in the breast. IBC is associated with diffuse involvement of the breast with infiltrating, invasive tumor cells. In patients with IBC who present with a distinct mass, multiple tumors are often identified only on breast MRI.

What are the characteristic findings on MRI in patients with IBC?

Skin thickening, skin enhancement (due to edema), and enhancing extensions of tumor mass are the characteristic findings on MRI in patients with IBC. In one study, a discrete mass was found in 38% of patients, though many patients with IBC do not have a palpable lump in their breast or distinct density on mammogram.

How accurate is MRI in evaluating patients with IBC?

MRI demonstrates skin thickening and skin enhancement in 90-100% of patients with IBC.

How accurate is MRI in evaluating patients with IBC who present with a mass?

In patients with IBC who have a mass on physical examination or diagnostic mammogram, MRI identifies the mass 100% of the time.

How effective is MRI in evaluating axillary nodes in patients with IBC?

MRI demonstrates axillary node involvement in 80% of patients diagnosed with IBC.

Does MRI identify any other abnormalities in patients with IBC?

MRI can be used to evaluate the axillary nodes in patients with IBC. And unlike mammogram and breast ultrasound, MRI can identify enlargement of the internal mammary artery (IMA) in 21% of patients diagnosed with IBC. Enlargement of the IMA results from increased blood flow to the tumor infiltrating the breast.

Can MRI differentiate IBC from breast infection (mastitis)?

MRI cannot differentiate between IBC and mastitis. However, MRI is rarely, if ever, used in the diagnosis of mastitis and only becomes an important imaging study when a patient thought to have mastitis fails to respond to antibiotic therapy and is subsequently referred to a breast specialist, at which time she is often sent for diagnostic studies including breast MRI.

Inflammatory breast cancer is an uncommon, aggressive, and rapidly progressive type of breast cancer associated with a high local recurrence rate and low overall mortality. Rapid onset of symptoms mimicking breast infection (redness, swelling, warmth, and pain) are the characteristic findings in patients with IBC. Mammogram imaging is less sensitive in cases of IBC than in the more common forms of breast cancer. Often patients with IBC have no distinct mass on physical examination or mammogram. Rather, the breast is diffusely swollen, edematous, full, and frequently hard to the touch. Breast MRI is a highly sensitive imaging study that is presently the diagnostic test of choice in evaluating patients suspected of having inflammatory breast cancer. It is also useful in evaluating response to treatment once chemotherapy has begun.

 

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