Skip to main content

Advertisement

SpringerLink
Log in

Inflammatory breast carcinoma and locally advanced breast carcinoma: characterisation with MR imaging

Carcinoma infiammatorio della mammella e carcinoma mammario localmente avanzato: possibilità di caratterizzazione mediante l’imaging RM

  • Breast Radiology / Senologia
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study was done to identify the typical magnetic resonance (MR) imaging findings of inflammatory breast carcinoma (IBC) in comparison with noninflammatory locally advanced breast carcinoma (LABC).

Materials and methods

MR images of 30 patients with IBC (T4d) were compared with those of a cohort of 30 patients with LABC (T3/T4a–c). The age distribution was approximately equal in the two groups. MR images were assessed for the following features: skin thickening (>4 mm), skin oedema, architectural distortion, enhancement pattern (mass-like/non-mass-like), time-signal intensity curve (continuous-persistent type/wash-out type), skin enhancement. Fisher’s exact text was used to compare MR imaging appearances of IBC and LABC (significant p value <0.05).

Results

Skin involvement and enhancement pattern differed between groups: skin thickening was present in 16/30 IBC (53%) vs 8/30 LABC cases (27%, p=0.06), skin oedema was present in 26/30 IBC (87%) vs 8/30 LABC (27%, p < 0.0001), and skin enhancement in 10/30 IBC (33%) vs 2/30 LABC (7%, p=0.02); non-mass-like enhancement was present in 22/30 IBC (73%) vs 12/30 LABC (40%, p=0.02).

Conclusions

IBC is a distinct clinical and pathological entity resulting in typical MR imaging features. Skin changes (thickening, oedema, enhancement) related to neoplastic involvement of the dermal lymphatics are suggestive of IBC and should prompt a skin biopsy to confirm or rule out the diagnosis.

Riassunto

Obiettivo

Obiettivo di questo lavoro è stato verificare l’esistenza di rilievi in risonanza magnetica (RM) specifici di carcinoma infiammatorio e dimostrarne l’accuratezza nella differenziazione del carcinoma infiammatorio (IBC) rispetto al tumore mammario localmente avanzato (LABC).

Materiali e metodi

Le indagini RM mammarie di 30 pazienti con carcinoma infiammatorio (T4d) sono state esaminate confrontandole con quelle del gruppo di controllo costituito da 30 pazienti con carcinoma localmente avanzato non infiammatorio T3/T4a–c). L’età delle pazienti era distribuita in maniera analoga nei due gruppi. Gli aspetti RM analizzati sono stati: ispessimento della cute (>4 mm), edema cutaneo, distorsione architetturale, pattern di impregnazione (tipo massa/tipo non-massa), curva dell’intensità di segnale nel tempo (tipo continuativo/persistente/tipo wash-out), impregnazione della cute. Il test esatto di Fischer è stato utilizzato per confrontare i rilievi RM nei casi di carcinoma infiammatorio rispetto a quelli di carcinoma localmente avanzato (significatività p<0,05).

Risultati

Comparando i rilievi RM nel carcinoma infiammatorio rispetto al tumore localmente avanzato sono state osservate significative differenze per quanto riguarda le alterazioni cutanee — più frequenti nel carcinoma infiammatorio — e il pattern di impregnazione. In particolare, ispessimento cutaneo si è rilevato in 16/30 (53%) IBC vs 8/30 (27%) LABC (p=0,06), edema cutaneo era presente in 26/30 (87%) IBC vs 8/30 (27%) LABC (p<0,0001), impregnazione della cute in 10/30 (33%) IBC vs 2/30 (7%) LABC (p=0,02); impregnazione diffusa tipo non-massa in 22/30 (73%) IBC vs 12/30 (40%) LABC (p=0,02).

Conclusioni

Il carcinoma infiammatorio rappresenta un’entità clinica e biologica distinta dal carcinoma localmente avanzato risultante in peculiari rilievi RM. Le alterazioni della cute (ispessimento, edema, impregnazione) sostenute dall’infiltrazione neoplastica dei linfatici del derma sono segni suggestivi di carcinoma infiammatorio e devono guidare al controllo bioptico della cute per confermare o escluderne la diagnosi.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Chia S, Swain SM, Byrd DR, Mankoff DA (2008) Locally advanced and inflammatory breast cancer. J Clin Oncol 26:786–790

    Article  PubMed  Google Scholar 

  2. Hance KW, Anderson WF, Devesa SS et al (2005) Trends in inflammatory breast carcinoma incidence and survival: the surveillance, epidemiology, and end results program at the National Cancer Institute. J Natl Cancer Inst 97:966–975. DOI 10.1093/jnci/dji172

    Article  PubMed  Google Scholar 

  3. Singletary SE, Cristofanilli M (2008) Defining the clinical diagnosis of inflammatory breast cancer. Semin Oncol 35:7–10

    Article  PubMed  Google Scholar 

  4. Amparo RS, Angel CD, Ana LH et al (2000) Inflammatory breast carcinoma: pathological or clinical entity? Breast Cancer Res Treatment 64:269–273

    Article  CAS  Google Scholar 

  5. Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 15:2483–2493

    CAS  PubMed  Google Scholar 

  6. Cristofanilli M, Valero V, Buzdar AU et al (2007) Inflammatory breast cancer (IBC) and patterns of recurrence: understanding the biology of a unique disease. Cancer 110:1436–1444. DOI 10.1002/cncr.22927

    Article  PubMed  Google Scholar 

  7. Mann RM, Kuhl CK, Kinkel K, Boetes C (2008) Breast MRI: guidelines from the European Society of The Breast Imaging. Eur Radiol 18:1307–1318

    Article  CAS  PubMed  Google Scholar 

  8. Sardanelli F, Giuseppetti GM, Canavese G et al (2008) Indications for breast magnetic resonance imaging. Consensus document “Attualità in senologia”, Florence 2007. Radiol Med 113:1085–1095

    Article  CAS  PubMed  Google Scholar 

  9. Martincich L, Montemurro F, Cirillo S et al (2003) Role of magnetic resonance imaging in the prediction of tumor response in patients with locally advanced breast cancer receiving neoadjuvant chemo-therapy. Radiol Med 106:51–58

    PubMed  Google Scholar 

  10. Londero V, Bazzocchi M, Del Frate C et al (2004) Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol 14:1371–1379

    Article  PubMed  Google Scholar 

  11. Thukral A, Thomasson DM, Chow CK et al (2007) Inflammatory breast cancer: dynamic contrast-enhanced MR in patients receiving bevacizumab—initial experience. Radiology 244:727–735

    Article  PubMed  Google Scholar 

  12. Yang WT, Le-Petross HT, Macapinlac H et al (2008) Inflammatory breast cancer: PET/TC, MRI, mammography and sonography findings. Breast Cancer Res Treat 109:417–426

    Article  CAS  PubMed  Google Scholar 

  13. Belli P, Costantini M, Romani M, Pastore G (2002) Role of magnetic resonance imaging in inflammatory carcinoma of the breast. RAYS 27:299–305

    PubMed  Google Scholar 

  14. Renz DM, Baltzer PA, Böttcher J et al (2008) Magnetic resonance imaging of inflammatory breast carcinoma and acute mastitis. A comparative study. Eur Radiol 18:2370–2380

    Article  PubMed  Google Scholar 

  15. Chow CK (2005) Imaging in inflammatory breast carcinoma. Breast Dis 22:45–54

    PubMed  Google Scholar 

  16. Kushwaha AC, Whitman GJ, Stelling CB et al (2000) Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol 174:535–538

    CAS  PubMed  Google Scholar 

  17. Caumo F, Gaioni MB, Bonetti F et al (2005) Occult inflammatory breast cancer: review of clinical, mammographic, US and pathologic signs. Radiol Med 109:308–320

    PubMed  Google Scholar 

  18. Tardivon AA, Viala J, Corvellec Rudelli A et al (1997) Mammographic patterns of inflammatory breast carcinoma: a retrospective study of 92 cases. Eur J Radiol 24:124–130

    Article  CAS  PubMed  Google Scholar 

  19. Lee KW, Chung SY, Yang I et al (2005) Inflammatory breast cancer: imaging findings. Clin Imaging 29:22–25

    PubMed  Google Scholar 

  20. Günhan-Bilgen I, Ustün EE, Memifl A (2002) Inflammatory breast carcinoma: mammographic, ultrasonographic, clinical, and pathologic findings in 142 cases. Radiology 223:829–838 DOI 10.1148/radiol.2233010198

    Article  PubMed  Google Scholar 

  21. Renz DM, Baltzer PAT, Bottcher J et al (2008) Inflammatory breast carcinoma in magnetic resonance imaging. A comparison with locally advanced breast cancer. Acad Radiol 15:209–221

    Article  PubMed  Google Scholar 

  22. Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual 6th edn. Springer, New York

    Google Scholar 

  23. American College of Radiology (2003) Breast imaging reporting and data system (BI-RADS) atlas, 4th edn. American College of Radiology, Reston, VA

    Google Scholar 

  24. Ellis CW (1987) Grading of invasive carcinoma of the breast. In: Page DL, Anderson TJ (eds) Diagnostic histopathology of the breast. Churchill Livingstone, Edinburgh, pp 311–330

    Google Scholar 

  25. Kuhl CK, Mielcarek P, Klaschik S et al (1999) Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions? Radiology 211:101–110

    CAS  PubMed  Google Scholar 

  26. Le-Petross CH, Bidaut L, Yang WT (2008) Evolving role of imaging modalities in inflammatory breast cancer. Semin Oncol 35:51–63

    Article  PubMed  Google Scholar 

  27. Vimpeli SM, Saarenmaa I, Huhtala H, Soimakallio S (2008) Large-core needle biopsy versus fine-needle aspiration biopsy in solid breast lesions: comparison of costs and diagnostic value. Acta Radiol 49:863–869

    Article  PubMed  Google Scholar 

  28. Manfrin E, Falsirollo F, Remo A et al (2009) Cancer size, histotype, and cellular grade may limit the success of fine-needle aspiration cytology for screen-detected breast carcinoma. Cancer Cytopathol. 117:491–499

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dipartimento di Radiologia, Policlinico Universitario “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    V. Girardi, G. Carbognin, L. Camera & R. Pozzi Mucelli

  2. Dipartimento di Patologia, Policlinico Universitario “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    F. Bonetti & E. Manfrin

  3. Dipartimento di Chirurgia, Policlinico Universitario “G.B. Rossi”, P.le L.A. Scuro 10, 37134, Verona, Italy

    G. Pollini

Authors
  1. V. Girardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Carbognin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Camera
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Bonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Manfrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Pollini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Pozzi Mucelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Girardi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Girardi, V., Carbognin, G., Camera, L. et al. Inflammatory breast carcinoma and locally advanced breast carcinoma: characterisation with MR imaging. Radiol med 116, 71–83 (2011). https://doi.org/10.1007/s11547-010-0590-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-010-0590-4

Keywords

Parole chiave

Search

Navigation