Abstract
BackgroundInflammatory breast cancer (IBC) is a clinical diagnosis. Here, we examined the association of a “classic” triad of clinical signs, swollen involved breast, nipple change, and diffuse skin change, with overall survival (OS).MethodBreast medical photographs from patients enrolled on a prospective IBC registry were scored by two independent reviewers as classic (triad above), not classic, and difficult to assign. Chi‐squared test, Fisher's exact test, and Wilcoxon rank‐sum test were used to assess differences between patient groups. Kaplan–Meier estimates and the log‐rank test and Cox proportional hazard regression were used to assess the OS.ResultsWe analyzed 245 IBC patients with median age 54 (range 26–81), M0 versus M1 status (157 and 88 patients, respectively). The classic triad was significantly associated with smoking, post‐menopausal status, and metastatic disease at presentation (p = 0.002, 0.013, and 0.035, respectively). Ten‐year actuarial OS for not classic and difficult to assign were not significantly different and were grouped for further analyses. Ten‐year OS was 29.7% among patients with the classic sign triad versus 57.2% for non‐classic (p < 0.0001). The multivariate Cox regression model adjusting for clinical staging (p < 0.0001) and TNBC status (<0.0001) demonstrated classic presentation score significantly associated with poorer OS time (HR 2.6, 95% CI 1.7–3.9, p < 0.0001).ConclusionsA triad of classic IBC signs independently predicted OS in patients diagnosed with IBC. Further work is warranted to understand the biology related to clinical signs and further extend the understanding of physical examination findings in IBC.
Highlights
Inflammatory breast cancer (IBC) is a rare and aggressive variant of breast cancer
Marked swelling of the involved breast is often noted at the time of diagnosis and nipple changes is a common finding among IBC cases.4,7–9 While it has been well-demonstrated that frank peau d'orange and other skin changes are prognostic for worse outcome in all patients, very little is known about the prognostic effect of variations in skin change on IBC presentation.10–12 For over 10 years in a dedicated IBC multi-disciplinary clinic, we increasingly associate the clinical signs triad of diffuse skin change, obvious swelling of the involved breast and nipple change, with an unambiguous diagnosis of IBC if the onset of the disease is rapidly occurring in
AJCC defines IBC, staged T4D as a clinical diagnosis characterized by diffuse erythema and edema involving at least one-third of the skin of the affected breast
Summary
Inflammatory breast cancer (IBC) is a rare and aggressive variant of breast cancer. It is increasingly recognized that not all skin change is overtly erythematous in IBC.[6] Marked swelling of the involved breast is often noted at the time of diagnosis and nipple changes (flattening or inversion) is a common finding among IBC cases.4,7–9 While it has been well-demonstrated that frank peau d'orange and other skin changes are prognostic for worse outcome in all patients, very little is known about the prognostic effect of variations in skin change on IBC presentation.10–12 For over 10 years in a dedicated IBC multi-disciplinary clinic, we increasingly associate the clinical signs triad of diffuse skin change (not solely limited to erythema), obvious swelling of the involved breast and nipple change, with an unambiguous diagnosis of IBC if the onset of the disease is rapidly occurring in
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
