How is inflammatory breast cancer diagnosed?

How is inflammatory breast cancer diagnosed?-First is through imaging tests. If inflammatory breast cancer (IBC) is suspected, the doctor will probably order an imaging test. A diagnostic mammogram is usually the first test ordered. Sometimes the swelling and tenderness can make it hard to do a good mammogram. The mammogram may show thickened skin, often without a visible mass (tumor). It can also show that the affected breast is larger and denser than the other breast. 

Often a breast ultrasound is ordered as well. The ultrasound is often able to show that lymph nodes under the arm are enlarged and may find breast masses (tumors) if they are present. Ultrasound can also be useful in guiding a needle for a biopsy procedure. 

Second is through MRI (magnetic resonance imaging). It can find breast tissue abnormalities if the mammogram result is normal. It can be used to guide a biopsy of those abnormal areas 

The next is CT (computed tomography) of the chest, abdomen, and pelvis is sometimes done to look for the spread of cancer. 

A PET (positron emission tomography) scan is another test that may be useful. This test is often combined with a CT scan. PET/CT can be useful in finding areas of cancer spread to lymph nodes and distant sites. 

With IBC it is important to document in detail the condition of the breast (how much redness and swelling is present). In some centers, a photo of the breast is taken to show the amount of redness and swelling before starting treatment. It is ideal to take the photo before breast biopsies because the biopsy itself can cause short-term swelling/bleeding. The doctor can then compare the current exam to the original photo to see how the cancer is responding to treatment. 

The next is Biopsy. Breast cancer is diagnosed by a biopsy, removing a sample of the breast tissue and looking at it under the microscope. Your physical exam and other tests may show findings that are "suspicious for" IBC, but only a biopsy can tell for sure that cancer is present. 

Breast biopsies can be done in many ways. Samples of breast tissue can be removed using fine needle aspiration (FNA), core needle biopsy, vacuum-assisted biopsy, or open (excisional or incisional) biopsies. The type of biopsy used depends on what area is affected and what it looks like. It also depends on whether a mass (tumor) can be seen on an imaging test (like MRI). A biopsy for IBC often involves a core needle biopsy under ultrasound or MRI guidance. IBC can also be diagnosed with a skin biopsy if no area deeper in the breast is identified on breast imaging. 

Biopsy samples will be looked at under the microscope to see if cancer is present. The cancer cells will be graded based on how abnormal they look. They will also be tested for certain proteins that help decide if certain treatments will be helpful.  Women whose breast cancer cells contain hormone receptors are likely to benefit from treatment with hormone therapy drugs. The cells are tested for the hormone receptors estrogen receptor (ER) and progesterone receptor (PR). If the cancer cells have those receptors they are called ER-positive, PR-positive, or just hormone receptor-positive.

Cancer cells are also tested to see if they contain too much of a protein called HER2/neu (often just called HER2 for short) or too many copies of the gene for that protein. If they do, the cancer is called HER2-positive, and the patient may be helped by certain drugs that target HER2.