Inflammatory breast cancer is diagnosed based on signs and symptoms. The inflammatory breast cancer diagnosis relies on the type of tumor, such as benign or malignant. There are different types of tests for the diagnosis of inflammatory breast cancer. Physical examination of the breast and surrounding lymph nodes, imaging tests for the breast and a biopsy of the breast and skin are also required to confirm the diagnosis of inflammatory breast cancer. Diagnostic mammography, ultrasound, magnetic resonance imaging (MRI), biopsy (aspiration biopsy, skin biopsy, core needle biopsy, surgical biopsy, image-guided biopsy, and sentinel lymph node biopsy), analysis of biopsy sample (Estrogen receptor and Progesterone receptor, HER2, and grade), blood tests (complete blood count, serum chemistry, blood tumor marker tests), additional tests including x-ray, bone scan, computed tomography (CT) scan, and positron emission tomography (PET) CT scan are the standard diagnostic approaches for inflammatory breast cancer.
Diagnostic Approach of Inflammatory Breast Cancer
Many tests are performed under the Diagnosis of Inflammatory Breast Cancer to find or diagnose cancer 1. Also, tests are done to learn if cancer has spread to parts other than where it started. The spread of the tumor to other regions is called metastasis.
Imaging tests show images of the inside of the body. However, imaging tests may not be as valuable as a biopsy for evaluating breast cancer.
A biopsy is a sure way to know if you have cancer in a particular part or organ of the body for most types of cancer.
The different tests can be used for a person depending upon the following factors:
- Your signs and symptoms
- The age and general health status
- The type of cancer suspected
- The result of earlier medical tests
Inflammatory breast cancer is diagnosed through a physical examination of the breast and surrounding lymph nodes and based on a person’s symptoms. Imaging Tests for the breast and a biopsy of the breast and skin are also required to confirm the diagnosis of inflammatory breast cancer.
A diagnostic mammogram is an x-ray of the breast. An x-ray is a method to create a picture of the structures inside the body using a small amount of radiation. It is similar to screening mammography, which looks for a possible breast tumor in people who have no symptoms. Diagnostic mammography is often used when experiencing signs like nipple discharge or a new lump 2. It is also used if something doubtful is found on the screening mammogram.
An ultrasound uses high-frequency sound waves to create a picture of the breast tissue. Ultrasound can differentiate between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.
Magnetic resonance imaging (MRI)
An MRI uses magnetic fields, not x-rays, to produce detailed body images. A specific dye known as contrast medium is given before the scan to create a better picture. A breast MRI can probably be used after a breast cancer diagnosis of Inflammatory Breast Cancer to check the other breast for cancer or determine how much the tumor has grown throughout the breast.
A biopsy removes a small part of tissue to examine under a microscope. A biopsy can also be done as part of surgery to remove the entire tumor. Surgery may be performed as a separate procedure if completely removing the tumor is not possible because of its position or a patient’s health.
There are different types of biopsies, categorized by the technique and size of the needle used to collect the tissue sample.
- 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.
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.
The tumor grade is also determined from the biopsy.
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.
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.
- 1.Molckovsky A, Fitzgerald B, Freedman O, Heisey R, Clemons M. Approach to inflammatory breast cancer. Can Fam Physician. 2009;55(1):25-31. https://www.ncbi.nlm.nih.gov/pubmed/19155362
- 2.Carney PA, Parikh J, Sickles EA, et al. Diagnostic Mammography: Identifying Minimally Acceptable Interpretive Performance Criteria. Radiology. Published online May 2013:359-367. doi:10.1148/radiol.12121216
- 3.Kumar N, Sayed S, Moloo Z, Wasike R. Fine-Needle Aspiration in Suspected Inflammatory Breast Cancer: Case Series with Emphasis on Approach to Specimen Adequacy. Acta Cytologica. Published online 2011:239-244. doi:10.1159/000324032
- 4.Yeh ED, Jacene HA, Bellon JR, et al. What Radiologists Need to Know about Diagnosis and Treatment of Inflammatory Breast Cancer: A Multidisciplinary Approach. RadioGraphics. Published online November 2013:2003-2017. doi:10.1148/rg.337135503
- 5.Dhamija E, Singh R, Mishra S, Hari S. Image-Guided Breast Interventions: Biopsy and Beyond. Indian J Radiol Imaging. Published online April 2021:391-399. doi:10.1055/s-0041-1734223
- 6.Chatterjee A, Serniak N, Czerniecki BJ. Sentinel Lymph Node Biopsy in Breast Cancer. The Cancer Journal. Published online January 2015:7-10. doi:10.1097/ppo.0000000000000090