Inflammatory breast cancer: Can contrast enhanced mammography help? Case series and literature review

Inflammatory breast cancer (IBC) is an uncommon, locally aggressive breast cancer with rapid onset of symptoms and an unfavorable prognosis. Diagnosis remains challenging and is frequently delayed; imaging plays an important role in disease detection and characterization. Contrast Enhanced Mammography (CEM) combines conventional mammography with a dual energy technique utilizing iodinated contrast, producing a set of recombined images that demonstrate contrast enhancement similar to magnetic resonance imaging (MRI) at a fraction of the cost and time. Current applications of CEM include the evaluation of abnormal findings on screening mammography, monitoring response to neoadjuvant chemotherapy, and assessment for tumor recurrence. CEM is mostly utilized in patients who are unable to undergo MRI. To our knowledge, CEM applications in IBC are scarce in the published literature. The following cases provide additional information on CEM use in the setting of IBC, from staging to guiding subsequent procedures to treatment response evaluation, emphasizing imaging findings and lessons learned. These cases also highlight the feasibility of CEM use in the setting of IBC, with potential incorporation into the future protocols for those patients unable to undergo MRI.