Inflammatory Breast Cancer (IBC)

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Inflammatory breast cancer (IBC):
    • Is a clinical syndrome in women with invasive breast cancer that is characterized by:
      • Erythema and edema (peau d’orange) of a third or more of the skin of the breast
    • The differential diagnosis includes:
      • Cellulitis of the breast or mastitis
    • Because most IBC cases are first seen by healthcare providers not necessarily familiar with IBC:
      • The absence of complete response to a trial of antibiotic therapy should heighten suspicion of IBC and prompt further investigation:
        • Further trial of antibiotics is not warranted in the absence of clinical signs of infection and previous adequate antibiotic therapy
    • Workup includes physical exam and imaging:
      • Imaging may not reveal a mass:
        • But thickening of the skin is frequently seen
      • The most common signs of IBC on mammography include:
        • Thickening of the skin (84%)
        • Trabecular thickening (81%)
        • Asymmetric focal density (61%)
        • Microcalcifications (56%)
      • Mammography is the least sensitive diagnostic tool available for IBC:
        • Whereas ultrasound and MRI are more sensitive:
          • In a series published by Yang, et al., sonography demonstrated a mass or architectural distortion in 95% of patients with associated global skin and subcutaneous thickening and dilated lymphatics
          • MRI can also show skin thickening and is more sensitive than mammography in detecting an underlying mass:
            • The same series by Yang and colleagues found that a primary breast lesion was present in every MRI obtained in patients with IBC as either nonmass or mass-like enhancement
    • IBC is a clinical diagnosis:
      • Dermal biopsy confirmation is not mandatory:
        • Dermal lymphatic invasion is seen only in approximately 60% of IBC cases:
          • It is neither required, nor sufficient by itself for a diagnosis of inflammatory breast cancer
    • Treatment is multidisciplinary trimodality therapy consisting of neoadjuvant chemotherapy, modified radical mastectomy, and local regional radiation:
      • Yet, the median survival at 5 years for patients presenting with primary IBC is still only approximately 55%
  • References
    • Yang WT, Le-Petross HT, Macapinlac H, et al: Inflammatory breast cancer: PET/CT, MRI, mammography, and sonography findings. Breast Cancer Res Treat. 2008;109(3):417-426.
    • Somio G, Jones V. Inflammatory breast cancer. In: Klimberg S, Bland K, eds. The Breast: Comprehensive Management of Benign and Malignant Disease. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2011:832-838.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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