Inflammatory breast cancer (IBC) is a clinical diagnosis made on the basis of a breast that rapidly enlarges; that is red, firm, and has skin edema (peau d’orange); and that involves 30% of the breast or more with a palpable border.
On evaluation of a specimen obtained by skin punch biopsy, the hallmark of this disease is dermal lymphatic invasion by tumor cells, but this pathologic finding is not necessary to make the diagnosis.
Nearly all women with IBC have lymph node involvement at the time of diagnosis, and sentinel lymph node biopsy has been shown to have a high false-negative rate in these patients. Hence, sentinel node biopsy is not indicated.
Approximately 30% of women with IBC will have distant metastatic disease; thus, all women with IBC should have a thorough staging work-up at the time of diagnosis.
As IBC has an American Joint Committee on Cancer (AJCC) stage of IIIb or higher (owing to its designation of T4d, N0-3, M0-1), neoadjuvant chemotherapy is the recommended first course of treatment.
Skin-sparing mastectomy is contraindicated.
Because the degree of pathologic response to neoadjuvant chemotherapy predicts prognosis, and the intensity of preoperative therapy predicts response, all chemotherapy up front instead of a so-called sandwich approach of chemotherapy/surgery/chemotherapy is preferred.
Surgery is indicated if disease responds well, as this gives the best chance for disease-free survival.
Post-mastectomy radiation therapy is required to reduce the risk of chest wall recurrence in these patients.
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National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Available at http://www.nccn.org.
Panades M, Olivotto IA, Speers CH, et al. Evolving treatment strategies for inflammatory breast cancer: a population-based survival analysis. J Clin Oncol. 2005;23:1941-1950.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 