By Dr. Kathleen Ruddy

Inflammatory breast cancer is an uncommon, aggressive form of breast cancer found in approximately 5% of cases in the United States. Rapid onset of symptoms (redness, swelling, edema, warmth, and pain in the breast) are hallmarks of the disease. Often there is no distinct mass associated with IBC. Early local recurrence and lower overall mortality are characteristic of IBC. Mammography is less sensitive in diagnosing and evaluating extent of disease in patients with IBC, therefore additional imaging studies are recommended. Breast MRI and PET-CT are particularly useful in staging and following patients with inflammatory breast cancer.

What is the advantage of PET-CT in patients with IBC?

PET-CT is an imaging study that generates a combined dynamic (functional) and anatomic image of breast tissue and regional lymph nodes. It can identify abnormal, malignant changes in the breast and lymph nodes and, at the same time, delineate the anatomic structures involved. This makes PET-CT a useful tool for assessing extent of disease in a patient with IBC.

Are there any other advantages of using PET-CT in patients with IBC?

PET-CT can identify metastatic spread of inflammatory breast cancer to other tissues and organs in the body. It can also identify multiple tumors in one breast or evidence of malignancy in the opposite breast.

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PET-CT is less useful in evaluating women with more common forms of breast cancer and is not considered helpful in evaluating women with early-stage disease.

Does PET-CT accurately evaluate skin involvement in patients with IBC?

Skin redness and edema are characteristic of IBC and are the consequence of diffuse spread of tumor cells to the lymphatic channels beneath the skin of the breast. PET-CT has been shown to be 100% accurate in identifying spread of tumor cells to the skin of the breast in patients with IBC.

How often does PET-CT demonstrate metastatic disease in women with IBC?

On average, about half of patients with IBC who undergo PET-CT have distant metastases at the time of diagnosis.

Why is it important to accurately evaluate extent of disease in patients with IBC?

Patients with inflammatory breast cancer require aggressive combined therapy to improve their chances for survival. Treatment begins with chemotherapy, called ‘neoadjuvant’ or ‘induction’ chemotherapy. Surgery is then performed and always requires mastectomy because of the very high risk of local recurrence associated with IBC. Radiation therapy to the chest wall and lymph nodes is given following surgery to reduce the risk of local recurrence. Accurate assessment of the extent of disease prior to induction chemotherapy allows doctors to evaluate response to treatment and make adjustments accordingly.

Inflammatory breast cancer is an uncommon, aggressive form of breast cancer associated with a high local recurrence rate and low overall survival. Aggressive, combined therapy is required to best treat patients with IBC. Chemotherapy is given first and is then followed with mastectomy and radiation therapy in order to improve survival and reduce the risk for local recurrence. PET-CT has been shown to be useful in accurately staging extent of disease in patients with IBC and is useful in documenting response to therapy.

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