How is inflammatory breast cancer diagnosed?

Imaging tests

If inflammatory breast cancer (IBC) is suspected, a diagnostic mammogram is 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.

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

Another test that may be useful is called a PET (positron emission tomography) scan. This test is often combined with a CT (computed tomography) scan. It can be useful in finding areas of cancer spread to lymph nodes and distant sites. PET/CT is one of the best ways to find IBC that has spread to the nearby and distant lymph nodes, which are among the most common sites of IBC spread.

It is important that every woman with a diagnosis of IBC has the condition of the breast (how much redness and swelling is present) well documented. In some centers, a photo of the breast is taken for those purposes prior to 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.

More information about these tests can be found in our document called Breast Cancer.

Biopsy

The diagnosis of any type of breast cancer is made 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), large core biopsy, vacuum−assisted biopsy, or open (excisional or incisional) biopsies—depending on where the affected area is, what it looks like, and who finds it. A biopsy in 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.