Abstract
The diagnosis of inflammatory breast cancer (IBC) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in North Africa where a higher proportion of breast cancer is diagnosed as IBC than in the United States (U.S.). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute (NCI) – Cairo, Egypt, and the Institut Salah Azaiz (ISA), Tunisia, recorded extent and duration of signs/symptoms of IBC on standardized forms, and took digital photographs of the breast. After second-level review at study hospitals, photographs and clinical information for confirmed IBC cases were reviewed by two U.S. oncologists. We calculated percent agreement between study hospital and U.S. oncologist diagnoses. Among cases confirmed by at least one U.S. oncologist, we calculated median extent and duration of signs and Spearman correlations. At least one U.S. oncologist confirmed the IBC diagnosis for 69% (39/50) of cases with photographs at the NCI-Cairo and 88% (21/24) of cases at the ISA. All confirmed cases had at least one sign of IBC (erythema, edema, peau d'orange) that covered at least one-third of the breast. The median duration of signs ranged from 1 to 3 months; extent and duration of signs were not statistically significantly correlated. From the above-mentioned outcomes, it can be concluded that the diagnosis of a substantial proportion of IBC cases is unambiguous, but a subset is difficult to distinguish from other types of locally advanced breast cancer. Among confirmed cases, the extent of signs was not related to delay in diagnosis.
Highlights
Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer characterized by the rapid clinical appearance of erythema, edema, and peau d’orange of the breast thought to result from the presence of tumor emboli in the breast dermal lymphatics
They evaluated the photographs for characteristics of IBC, such as presence of erythema, edema, and peau d’orange, and used their clinical judgment to distinguish these signs from those associated with other types of locally advanced breast cancer [9]
We did a systematic review of the diagnosis of IBC at two hospitals in North Africa, where a higher proportion of breast cancers have been reported to be IBC than in the U.S We used digital photographs, detailed clinical information, and multiple levels of review
Summary
Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer characterized by the rapid clinical appearance of erythema (redness), edema, and peau d’orange of the breast thought to result from the presence of tumor emboli in the breast dermal lymphatics. The diagnosis of IBC is primarily clinical; a tissue diagnosis is still necessary to establish invasive breast cancer. Diagnosis of Inflammatory Breast Cancer required for IBC has not been well standardized [1]; the seventh edition of the American Joint Committee on Cancer (AJCC) suggests that diffuse erythema and edema (peau d’orange) should involve a third or more of the breast [2]. Neglected locally advanced breast cancers presenting late in the course of disease are not to be considered IBC [2]
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