Breast inflammation: indications for MRI and PET-CT

Area of Science:

• Oncology
• Radiology
• Medical Imaging

Background:

• Differentiating inflammatory breast cancer (IBC) from acute mastitis (AM) can be challenging.
• Early and accurate diagnosis is crucial for effective treatment of IBC.

Purpose of the Study:

• To clarify the role of breast MRI in the differential diagnosis of inflammatory breast cancer and acute mastitis.
• To evaluate the utility of advanced imaging techniques like MRI and PET-CT in staging and treatment monitoring of IBC.

Main Methods:

• Review of current diagnostic guidelines and clinical practices.
• Discussion of the diagnostic performance of MRI, ultrasound, mammography, and histological sampling.
• Evaluation of PET-CT and MRI for staging and response assessment.

Main Results:

• Breast MRI is not advised for initial differentiation between IBC and AM.
• Persistent mastitis symptoms warrant further investigation with MRI, ultrasound, mammography, and histology to rule out IBC.
• MRI is valuable for detecting contralateral lesions; PET-CT is useful for distant metastases and local/regional lymph node assessment for treatment planning.
• MRI and PET-CT can identify poor responders to neoadjuvant chemotherapy for timely treatment modification.

Conclusions:

• Breast MRI should not be the primary tool for distinguishing inflammatory breast cancer from acute mastitis.
• Advanced imaging plays a critical role in staging, treatment guidance, and response assessment for inflammatory breast cancer.