How to Define Inflammatory Breast Cancer: A Systematic Review

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Inflammatory breast cancer (IBC) diagnosis is primarily clinical, often based on subjective skin changes.
• Variability in diagnostic criteria can lead to challenges in identifying IBC accurately.

Purpose of the Study:

• To systematically review and synthesize recent literature (2010-2023) on the definition and diagnostic criteria for IBC.
• To identify key clinical, imaging, and pathological features crucial for accurate IBC diagnosis.

Main Methods:

• A systematic review of MEDLINE and PubMed databases was conducted.
• Search terms included "inflammatory breast cancer," "diagnosis," "criteria," and "definition" within a 13-year timeframe.
• 24 relevant studies were evaluated for clinical, imaging, and pathological findings.

Main Results:

• Clinical criteria are paramount, with skin changes (erythema, edema, peau d'orange) present in 100% of studies.
• Rapid onset (<6 months) and involvement of at least one-third of the breast were significant clinical indicators.
• Imaging findings like diffuse breast/skin thickening and MRI features (heterogeneous enhancement, edema) are important; pathology may show lymphatic tumor emboli.

Conclusions:

• IBC should be suspected with rapid-onset erythema and edema, irrespective of extent.
• Mammography and ultrasound are recommended for suspected IBC to detect diffuse involvement and lymph node status.
• MRI and skin biopsy can aid diagnosis when initial findings are unclear or no mass is evident.