Diagnosis of Inflammatory Breast Cancer

The different tests can be used for a person depending upon the following factors: 

Diagnostic mammography

Ultrasound

Magnetic resonance imaging (MRI)

Biopsy –

• A fine-needle aspiration biopsy uses a thin needle to take out a small sample of cells ^​3​.
• A core needle biopsy uses a wider needle to remove a larger sample of tissue. It is usually the preferred way to determine whether an abnormality on a physical examination or an imaging test is cancer. A vacuum-assisted biopsy removes many large cores of tissue. Local anesthesia, which is medication to block pain, is used to lessen a patient’s discomfort during the procedure. There may be no single primary tumor for inflammatory breast cancer, so more than one core biopsy may be needed to diagnose cancer.
• A skin biopsy is mainly used to help diagnose inflammatory breast cancer but is not always needed. Inflammatory breast cancer cells can move through lymph vessels in the skin, so a skin biopsy can help determine if inflammatory breast cancer cells are in the skin ^​4​.
• A surgical biopsy removes the most significant amount of tissue. This biopsy can be incisional or excisional. An incisional biopsy is the removal of some part of the lump. An excisional biopsy is the removal of the whole lump. Because surgery is best done after cancer is diagnosed, a surgical biopsy is usually not recommended to diagnose breast cancer. Most often, non-surgical core needle biopsies are advised to diagnose breast cancer. Hence, only one surgical procedure is needed to remove the tumor and take samples of the lymph nodes. An incisional biopsy is seldom used to diagnose breast cancer, but it may be required if the core needle biopsies are not helpful to diagnose cancer.
• An image-guided biopsy is used when a lump cannot be felt, but an abnormality is seen in an imaging test like a mammogram ^​5​. A needle is guided to the location during this procedure using an imaging technique, like ultrasound, mammography, or MRI. A stereotactic biopsy is done using mammography to help guide the needle. An image-guided biopsy can be done using a fine needle, core, or vacuum-assisted biopsy, depending on the amount of tissue removed. For the diagnosis of inflammatory breast cancer, imaging can help identify the best position to take a biopsy sample when a precise mass is not felt.
• Sentinel lymph node biopsy is a method to determine whether Inflammatory Breast Cancer is present in the lymph nodes around the breast ^​6​. This type of biopsy is not used generally for inflammatory breast cancer. The most preferred way to examine lymph nodes is with an axillary lymph node dissection for inflammatory breast cancer. If there is cancer in the lymph nodes, the cancer is called ‘lymph node-positive breast cancer’ or ‘node-positive.’ If there is no cancer in the lymph nodes, the cancer is called ‘lymph node-negative breast cancer’ or ‘node-negative.’

Also Read: Breast Self Examination at Home

Analyzing a Biopsy sample for Inflammatory Breast Cancer

Tumor features are used to determine if it is invasive and has spread to the lymph nodes. Inflammatory breast cancer is always invasive.

ER and PR –

Testing for ER and PR helps determine the patient’s chances of recurrence and the type of treatment likely to lessen the risk of recurrence. Inflammatory breast cancer is mostly ER or PR negative. However, many inflammatory breast cancers are ER or PR positive.

HER2 –

The HER2 status helps determine whether drugs that target the HER2 receptor might help treat cancer. Inflammatory breast cancer is HER2 primarily negative but can sometimes have these receptors.

Grade –

The tumor grade is also determined from the biopsy. 

Blood Tests

Complete blood count –

A total blood count is used to measure the number of different cells, like red blood cells and white blood cells, in a sample of a person’s blood. It is done to check if your bone marrow is functioning. 

Serum chemistry –

Serum chemistry tests are mostly done to see the minerals in your blood, like potassium and sodium. They also evaluate the health of kidneys and liver.

Blood tumor marker tests –

Serum tumor markers are tumor proteins in a person’s blood. Higher levels of a serum tumor marker may be from cancer or a noncancerous condition. Tumor marker testing is typically used to monitor the growth of metastatic breast cancer, along with symptoms and imaging tests. Tumor marker tests are usually not needed for people without metastatic breast cancer. It should not be used to monitor for a recurrence, as such testing does not appear to improve a patient’s chance of recovery.

Additional tests

X-ray –

An x-ray is a method to create an image of the structures present inside the body using a small quantity of radiation. A chest x-ray can be used for cancer that has spread from the breast to the lungs.

Bone scan –

A bone scan utilizes a radioactive tracer to look inside the bone. It can help find whether cancer has spread to other places in the bone and how much damage it has caused. 

Healthy bone seems lighter to the camera, and areas of injury, such as those caused by cancerous cells, stand out on the image.

Computed Tomography (CT scan) –

A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines photos into a detailed, 3-dimensional image that shows abnormalities or tumors. At times, a special dye known as contrast medium is given before the scan to provide superior detail on the image. This dye can be delivered into a patient’s vein or given as a pill or liquid to swallow. CT scans may be used to guide the biopsy needle.

Positron emission tomography (PET) or PET-CT scan –

A PET scan creates images of organs and tissues present inside the body. A small quantity of a radioactive substance is injected into the patient’s body which is taken up by cells using the most energy. The cancer cells which use energy actively take up the radioactive substance, and the scanner then spots this substance to produce images of the inside of the body. In bone cancer, this scan provides a more comprehensive view to determine the presence of abnormal activity, even before a tumor may have developed.         

After the tests for diagnosis are done, the doctor will analyze all the results with you. If the diagnosis is cancer, these results can help the doctor to describe cancer.

References