Lack of uniform diagnostic criteria for inflammatory breast cancer limits interpretation of treatment outcomes: A systematic review
ABSTRACT Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer. No randomized controlled trial or systematic review with an IBC-only cohort that evaluates interventions has been published. We conducted a systematic review of the literature to characterize the reporting of clinical criteria and response to neoadjuvant therapy for IBC.
We searched MEDLINE and other sources for the following: previously untreated patients with IBC without metastasis in cohort studies; utilized chemotherapy; and reported clinical outcomes. The following 4 groups were analyzed: no anthracycline induction, low-dose anthracycline induction, moderate-dose anthracycline induction, and high-dose chemotherapy requiring stem cell support. Weighted averages for the overall response rates were calculated using a random effects model.
Twenty-seven studies met all criteria, totaling 1232 patients. Clinical description of IBC eligibility criteria and reported response assessments varied significantly among studies. The response rates and 3- and 5-year overall survival for all 27 studies ranged from 14% to 100%, 22% to 84%, and 32% to 75%, respectively. Pathologic complete response rates after no anthracycline induction, low-dose anthracycline induction, moderate-dose anthracycline induction, and neoadjuvant high-dose chemotherapy subgroups were 4% (95% confidence interval [CI], 1%-18%), 11% (95% CI, 7%-17%), 14% (95% CI, 8%-22%), and 32% (95% CI, 24%-41%), respectively.
The criteria and reporting of IBC and treatment response was notably variable, with significant potential for subject heterogeneity. Pathologic complete response rates appear to be related to intensity of neoadjuvant treatment; however, this analysis is not based on randomized data. Future clinical trials should define and report the criteria for IBC diagnosis and response assessment to enhance interstudy comparisons.
SourceAvailable from: Anna Badowska-Kozakiewicz
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ABSTRACT: Inflammatory breast cancer (IBC) is a relatively rare and extremely aggressive form of breast cancer that is diagnosed clinically. Standardization of clinical diagnoses is challenging, both nationally and internationally; moreover, IBC coding definitions used by registries have changed over time. This study aimed to compare diagnostic factors of IBC reported in a U.S. Surveillance, Epidemiology, and End Results (SEER) registry to clinical criteria found in the medical records of all invasive breast cancer cases at a single institution. We conducted a medical record review of all female invasive breast cancers (n = 915) seen at an NCI-designated comprehensive cancer center in Detroit from 2007 to 2009. IBC cases were identified based on the presence of the main clinical characteristics of the disease (erythema, edema, peau d'orange). We compared the proportion of IBC out of all breast cancers, using these clinical criteria and the standard SEER IBC codes. In the reviewed cases, the clinical criteria identified significantly more IBC cases (n = 74, 8.1%) than the standard IBC SEER definition (n = 19, 2.1%; p < 0.0001). No IBC cases were identified in the cancer center records using the SEER pathologic coding, which requires the diagnosis of inflammatory carcinoma on the pathology report, a notation that is rarely made. Emphasis must be placed on the documentation of clinical and pathologic characteristics of IBC in the medical record, so that analysis of putative IBC subtypes will be possible. Our results indicate the need for a consensus on the definition of IBC to be utilized in future research.The Breast Journal 12/2013; 20(2). DOI:10.1111/tbj.12234 · 1.43 Impact Factor
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ABSTRACT: Background: Inflammatory breast cancer (IBC) is an aggressive form of locally advanced breast cancer characterized by rapidly progressive breast erythema, pain and tenderness, oedema and paeu d'orange appearance. It accounts for 1-3% of all newly diagnosed cases of breast cancer in the west. Data on IBC from India are lacking. The aim of our study was to assess the clinical-pathological parameters and outcome of IBC at, All India Institute of Medical Sciences, a large tertiary care centre. Materials and Methods: We screened 3,650 breast cancer cases registered from January 2004 to December 2012 and found 41 cases of IBC. Data included demographics as well as clinical, radiological and histopathological characteristics, and were collected from clinical case records using the International Classification of Diseases code (C-50). Patients who presented with IBC as a recurrence, or who had a neglected and advanced breast cancer that simulated an IBC were excluded from this study. Results: The median age was 45 years (range 23-66). The median duration of symptoms was 5 months. The American Joint Committee on Cancer stage (AJCC) distribution was Stage III - 26 and IV - 15 patients. Estrogen receptor (ER), progesterone receptor (PR) positivity and human epidermal growth factor receptor 2 (HER2/neu) positivity were 50%, 46% and 60%, respectively. Triple negativity was found in 15% of the cases. All the non metastatic IBC patients received anthracycline and/ or taxane based chemotherapy followed by modified radical mastectomy , radiotherapy and hormonal therapy as indicated. Pathological complete remission rate was 15%. At a median follow-up of 30 months, the 3 year relapse free survival and overall survival were 30% and 40%respectively. Conclusion: IBC constituted 1.1% of all breast cancer patients at our centre. One third of these had metastatic disease at presentation. Hormone positivity and Her2 neu positivity were found in 50% and 60% of the cases, respectively.Asian Pacific journal of cancer prevention: APJCP 04/2014; 15(7):3207-10. DOI:10.7314/APJCP.2014.15.7.3207 · 1.50 Impact Factor