When you go to your primary care doctor about a breast problem, two people you may never meet will be critical in diagnosing whether you have IBC — the radiologist and the pathologist. I recently learned more about these doctors at the Morgan Welch Inflammatory Breast Cancer 10th Anniversary Conference in Houston, Texas, Feb. 11-12, 2017.
Mammograms, ultrasounds, and MRIs
Inflammatory breast cancer (IBC) is sometimes referred to inaccurately as the breast cancer that mammograms cannot find. This form of breast cancer grows in the lymph vessels in the skin of the breast, so it is typically spread throughout the breast rather than concentrated in a lump.
In her presentation, Carisa Le-Petross, M.D., F.R.C.P.C., F.B.S.I., reviewed the ways in which radiologists use imaging tests to help diagnose IBC. A mammogram is usually the first test a doctor orders. According to Dr. Le-Petross, mammograms can note calcifications, distorted areas, and skin thickening that may suggest IBC. Changes in images from one year to the next or between the two breasts offer clues that something may be wrong and that your doctor needs to investigate further. Dr. Le-Petross feels that ultrasounds are better for diagnosing IBC. The edema (swelling), which is a frequent symptom in IBC, is caused by fluid build-up. Ultrasounds are excellent at finding fluid, and they can also measure skin thickness. Breast MRIs offer another way to figure out what is happening. The MRI can identify the pattern of blood flow within the breast, where more blood vessels may indicate IBC.
None of these tests can diagnose IBC, but they help the surgeon decide the best places to biopsy, if necessary. Because there is not usually a lump to biopsy, at least two skin punch biopsies should be taken and sent to the next important person in your diagnostic process.
Savitri Krishnamurthy, M.D., discussed the role of the pathologist in the diagnosis and management of IBC. The pathologist looks at the biopsy tissue and decides whether cancer is present. A patient’s symptoms could be caused by mastitis, dermatitis, other forms of cancer, or even congestive heart failure. The pathologist studies the biopsy sample for all possible causes of the symptoms to determine the diagnosis.
The pathologist is also part of the team that stages the cancer by providing information about its extent and aggressiveness. Another crucial piece of information that the pathologist provides is the subtype of the cancer cells. Are they hormone-receptor positive? Do they overexpress a protein called HER2? Getting the subtype right is vital for determining the correct treatment.
A second opinion?
Because IBC is uncommon and its appearance overlaps with other conditions, getting the correct diagnosis can be a challenge. I will always be grateful that the pathologists at my local hospital decided to send my slides to an expert in IBC diagnosis at a major cancer center. It is perfectly appropriate for patients to ask for another radiologist or pathologist to review images and slides.
The radiologist and pathologist may become involved in your treatment again as the doctor decides whether your treatment is working or your cancer has spread. Their involvement at this stage is just one more way in which the radiologist and pathologist are important people on your treatment team, even if you never meet them.
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Phyllis Johnson is an inflammatory breast cancer survivor who serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. She stays current on cancer information through attendance at conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. A retired teacher, she has been writing about cancer issues at HealthCentral since 2007.