Dear Amy:

Yours is an important question and you make some good observations, and I address the matter of consensus in IBC diagnosis below. I would first however just add that the differential diagnosis needs to also discriminate IBC not just from mastitis, but also from post-radiation cellulitis, breast abscess, radiation dermatitis, and duct ectasia, as well as - although far more rarely - lymphoma and congestive heart failure which can cause unilateral breast edema (as shrewdly noted by Blackley Kute at Baptist Health, and others).

Now as to your query of standards or consensus in defining and diagnosing IBC:

The authoritative international standard on diagnosis of IBC was developed by a group of international experts who met at the First International Conference on Inflammatory Breast Cancer in December 2008, and their Consensus Statement was released as the document "International Expert Panel on Inflammatory Breast Cancer: Consensus Statement for Standardized Diagnosis and Treatment" [Dawood 2011]. Their eight-point diagnostic criteria are presented below (I have for clarity of exposition rearrange the order more cohesively):

Note that of these, only the first five are true clinical IBC-specific diagnostics, #6 above being breast carcinoma-confirmatory, while #7 and #8 are suggestive but not requisite.

These minimal diagnostic criteria have remained relatively consistent over later conferences: the Second International IBC Conference was held in 2010, the Third in 2012, the Fourth in 2014, the Fifth in 2016 and the Sixth International Inflammatory Breast Cancer Symposium will be held this year on September 19 to 21, 2018 in Madrid. And although in each of these, new diagnostic technologies are being explored including protein microarrays, as well as circulating tumor cells (CTCs) and circulating endothelial cells (CECs) for molecular diagnostics, nonetheless the original minimal requirements of IBC diagnosis I outlined above have remained stable.

In addition, originally inspired under the guiding hand of acclaimed "Father of IBC", Massimo Cristofanilli, national and international experts in IBC convene regular through the MD Anderson IBC Clinic and Research Program, the most recent being the Morgan Welch MD Anderson Cancer Center Inflammatory Breast Cancer (IBC) Program 10th Anniversary Conference [Woodward 2017].

In addition, the UK Inflammatory Breast Cancer Working group [Rea 2015] have published their own diagnostic criteria (see: https://www.nature.com/articles/bjc2015115/tables/1) that are largely congruent with those of the International Conference on Inflammatory Breast Cancer (above).

Furthermore, my colleague Tamer Fouad, currently at MD Anderson Cancer Center and at The National Cancer Institute at Cairo University, Egypt and other IBC experts note that in the U.S., the diagnosis of IBC relies exclusively on the clinical criteria as outlined by the American Joint Committee (AJC) TNM classification, but this as they correctly point out is problematic, as it channel patients meeting those criteria in subcategory T4d, but that has they effect of relegating all patients with non-metastatic IBC to stage III, regardless of tumor size or node-positivity, while patients with metastatic disease are consigned to stage IV, despite the fact the TNM classification does not differentiate patients on the basis of the presence of inflammatory criteria. Based on these real concerns, the group has issued what I regard as a highly important Personal View [Fouad 2017] that questions whether the current TNM staging classification accurately represents a distinction between patients with inflammatory and those with non-inflammatory breast cancer.

I would also add in support of the Personal View that the AJC's definition of IBC as a clinicopathologic entity characterized by diffuse erythema and edema (peau d’orange) of the breast with or without an underlying palpable mass can allow the term IBC to be used to clinically describe a neglected non-IBC Locally Advanced Breast Cancer (LABC), in agreement with other expert judgment [Alvarez 2015].

The above demonstrates that despite some extraordinary efforts, a true international consensus for IBC diagnosis has eluded us to date. We await therefore what the coming Sixth International Inflammatory Breast Cancer Symposium, as well as the Morgan Welch MD Anderson Cancer Center Inflammatory Breast Cancer (IBC) Program 11th Anniversary Conference will bring. In the interim, the somewhat dated International Expert Panel on Inflammatory Breast Cancer Consensus Statement for Standardized Diagnosis and Treatment remains predominant, although this should be tempered with the reservations expressed by Tamer Fouad and colleagues in their landmark Personal View [Fouad 2017].

REFERENCES

[Alvarez 2015] Alvarez R.H., Dawood S., Cristofanilli M. (2015) Inflammatory Breast Cancer. In: Riker A. (eds) Breast Disease. Springer, New York, NY.

[Dawood 2011] Dawood S, Merajver SD, Viens P, et al. International expert panel on inflammatory breast cancer: consensus statement for standardized diagnosis and treatment. Ann Oncol 2011 Mar; 22(3):515-23.

[Fouad 2017] Fouad TM, Barrera AMG, Reuben JM, et al. Inflammatory breast cancer: a proposed conceptual shift in the UICC-AJCC TNM staging system. Lancet Oncol. 2017 Apr; 18(4):e228-e232.

[Rea 2015] Rea D, Francis A, Hanby AM, et al. Inflammatory breast cancer: time to standardise diagnosis assessment and management, and for the joining of forces to facilitate effective research. British J Cancer 2015; 112:1613–1615.

[Woodward 2017] Woodward WA, Cristofanilli M, Merajver SD, et al. Scientific Summary from the Morgan Welch MD Anderson Cancer Center Inflammatory Breast Cancer (IBC) Program 10th Anniversary Conference. J Cancer 2017; 8(17): 3607–3614.

Constantine Kaniklidis

Director, Medical Research, No Surrender Breast Cancer Foundation (NSBCF)

Oncology Reviewer, Current Oncology

Society for Integrative Oncology (SIO)

European Association for Cancer Research (EACR)

Thanks Constantine Kaniklidis for the comprehensive review on diagnostic criteria for IBC.

Your effort is very much appreciated.

Thanks Constantine for the concise

review on diagnostic criteria for IBC.

Thank you so very much Constantine for the concise response. I shall share your summary with the Beast Care Centre's in New Zealand in order to help them to improve their diagnosis.

Dear Moawia and Neelam:

Thanks you both for your kind appreciation. Glad it was useful!

kind regards

Constantine

Dear Amy:

Thank you, glad it may prove of benefit, and feel free to share with folks in NZ (I was myself a member of the New Zealand Guidelines Group (NZGG) for many yeears).

I will report later this year to this Researchgate forum on the new developments and refinements that come out of the Sixth International Inflammatory Breast Cancer Symposium and MD Anderson Cancer Center Inflammatory Breast Cancer (IBC) Program 11th Anniversary Conference.

Best fortune.

Constantine Kaniklidis

Director, Medical Research, No Surrender Breast Cancer Foundation (NSBCF)

Oncology Reviewer, Current Oncology

Society for Integrative Oncology (SIO)

Member, European Association for Cancer Research (EACR)

Member, International CardiOncology Society, North America (ICOSNA)