Breast Cancer - Inflammatory: Diagnosis

Approved by the Lineagotica Editorial Board, 11/2018

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. However, imaging tests may not be as helpful as a biopsy (see below) for evaluating breast cancer. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy of the tumor is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. This is the most important step to make a diagnosis and to plan treatment. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

Inflammatory breast cancer is usually diagnosed through a physical examination of the breast and nearby lymph nodes and based on a person’s symptoms. Breast imaging tests and a biopsy of the breast and/or skin are also needed to confirm a diagnosis of inflammatory breast cancer.

Breast imaging tests

  • Diagnostic mammography. A diagnostic mammogram is an x-ray of the breast. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. It is similar to a screening mammography, which is used to look for a possible breast tumor in women who have no symptoms. A diagnostic mammography is often used when a woman is experiencing signs, such as nipple discharge or a new lump. It may also be used if something suspicious is found on a screening mammogram.

  • Ultrasound. An ultrasound uses high-frequency sound waves to create an image of the breast tissue. An ultrasound can distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given into the patient’s vein before the scan to help create a clear picture of the possible cancer. A breast MRI may be used after a woman has been diagnosed with cancer to check the other breast for cancer or to find out how much the disease has grown throughout the breast. It may also be used for screening, along with mammography, for some women with a very high risk of developing breast cancer.

Surgical tests

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. There are different types of biopsies, classified by the technique and/or size of needle used to collect the tissue sample.

  • A fine needle aspiration biopsy uses a thin needle to remove a small sample of cells.

  • A core needle biopsy uses a wider needle to remove a larger sample of tissue. This is usually the preferred biopsy technique for finding out whether an abnormality on a physical examination or an imaging test is cancer. A vacuum-assisted biopsy removes several large cores of tissue. Local anesthesia, which is medication to block pain, is used to lessen a patient’s discomfort during the procedure. For inflammatory breast cancer, there may be no single, main tumor, so more than 1 core biopsy may be needed to diagnose the cancer.

  • A skin biopsy is often used to help diagnose inflammatory breast cancer, but it is not always needed. Inflammatory breast cancer cells can travel through lymph vessels in the skin, so a skin biopsy can help find out if there are inflammatory breast cancer cells in the skin.

  • A surgical biopsy removes the largest amount of tissue. This biopsy may be incisional or excisional. An incisional biopsy is the removal of part of the lump. An excisional biopsy is the removal of the entire lump. Because surgery is best done after a cancer is diagnosed, a surgical biopsy is usually not the recommended way to diagnose breast cancer. Most often, non-surgical core needle biopsies are recommended to diagnose breast cancer. This means that only 1 surgical procedure is needed to remove the tumor and to take samples of the lymph nodes. An incisional biopsy is rarely used to diagnose breast cancer, but it may be needed if the core needle biopsies (see above) were not helpful to diagnose the cancer.

  • An image-guided biopsy is used when a distinct lump cannot be felt, but an abnormality is seen with an imaging test, such as a mammogram. During this procedure, a needle is guided to the location with the help of an imaging technique, such as mammography, ultrasound, or MRI. A stereotactic biopsy is done using mammography to help guide the needle. A small metal clip may be put into the breast to mark where the biopsy sample was taken, in case the tissue is cancerous and more surgery is needed. This clip is usually titanium so it will not cause problems with future imaging tests, but check with your doctor before you have additional imaging tests. An image-guided biopsy can be done using a fine needle, core, or vacuum-assisted biopsy (see above), depending on the amount of tissue being removed. This approach may be useful to diagnose inflammatory breast cancer as imaging may help identify the best place to take a biopsy sample when a distinct mass is not felt.

  • Sentinel lymph node biopsy is a way to find out if there is cancer in the lymph nodes near the breast. This type of biopsy is not usually used for inflammatory breast cancer. The preferred way to examine lymph nodes for inflammatory breast cancer is with an axillary lymph node dissection. If there is cancer in the lymph nodes, the cancer is called “lymph node-positive breast cancer” or “node-positive.” If there is no cancer in the lymph nodes, the cancer is called “lymph node-negative breast cancer” or “node-negative.” Learn more about sentinel lymph node biopsy and axillary lymph node dissection in the Types of Treatment section.

Analyzing the biopsy sample

Analyzing the sample(s) removed during the biopsy can help your doctor learn about specific features of a cancer that help determine treatment options.

  • Tumor features. Examination of the tumor under the microscope is used to determine if it is invasive and has spread to the lymph nodes. Inflammatory breast cancer is always invasive.

  • ER and PR. Testing for ER and PR helps determine both the patient’s risk of recurrence and the type of treatment that is most likely to lower the risk of recurrence. As mentioned in the Introduction section, inflammatory breast cancer is often ER/PR negative. However, some inflammatory breast cancers are ER/PR positive. Learn about ER and PR testing recommendations from ASCO and the College of American Pathologists (CAP).

  • HER2. The HER2 status helps determine whether drugs that target the HER2 receptor might help treat the cancer. As mentioned in the Introduction section, inflammatory breast cancer is often HER2 negative but can sometimes have these receptors. Read ASCO’s and CAP's recommendations for HER2 testing for breast cancer.

  • Grade. The tumor grade is also determined from the biopsy. The grade describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade may help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

Your doctor may recommend additional laboratory tests on your tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This helps your doctor find out the subtype of cancer.

Blood tests

The doctor may also need to do blood tests to learn more about your health:

  • Complete blood count. A complete blood count (CBC) is used to measure the number of different types of cells, such as red blood cells and white blood cells, in a sample of a person’s blood. It is done to make sure that your bone marrow is functioning well.

  • Serum chemistries. These tests are often done to look at minerals in your blood, such as potassium and sodium. They also evaluate the health of your kidneys and liver.

  • Blood tumor marker tests. Serum tumor markers are tumor proteins in a person's blood. Higher levels of a serum tumor marker may be from cancer or a noncancerous condition. Tumor marker testing is typically used to monitor the growth of metastatic breast cancer, along with symptoms and imaging tests. Tumor marker tests are usually not needed for people without metastatic breast cancer and should not be used to monitor for a recurrence, as such testing does not appear to improve a patient’s chance of recovery. Learn more about tumor markers for breast cancer.

Additional tests

Whether your doctor recommends additional imaging tests to find out if the cancer has spread depends on your medical history, symptoms, how much the disease has grown in the breast and lymph nodes, and the results of your physical examination. Read the Stages section for more information. These tests are not recommended for all patients.

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation. A chest x-ray may be used to look for cancer that has spread from the breast to the lungs.

  • Bone scan. A bone scan may be used to look for spread of cancer to the bones. A radioactive dye or tracer is injected into a patient’s vein, and then the scan is performed several hours later using a special camera. The tracer collects in areas of the bone that are healing, which occurs in response to damage from the cancer cells. The areas where the tracer collects stand out on the images, compared to healthy bone, which appears gray. Some cancers do not cause the same healing response and will not show up on the bone scan. Areas of advanced arthritis or healing after a fracture will also show up on the image.

  • Computed tomography (CT or CAT) scan. A CT scan may be used to look for tumors in organs outside of the breast, such as the lung, liver, bone, and lymph nodes. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows abnormalities, including most tumors. A CT scan can be used to measure the tumor’s size and if it is shrinking with treatment. A contrast dye may be injected into a patient’s vein before the scan to provide better detail.

  • Positron emission tomography (PET) scan. A PET scan may also be used to find out whether the cancer has spread to organs outside of the breast. A PET scan is usually combined with a CT scan (see above). However, you may hear your doctor refer to this procedure just as a PET scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into a patient’s vein. This sugar substance is then taken up by cells that use the most energy because they are actively dividing. Because cancer cells tend to use energy actively, they absorb more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body. Areas that are most active appear as bright spots, and the intensity of the brightness can be measured to better describe these areas. A PET scan may also be used to measure the size of tumors and to determine the location of the bright spots more accurately. This test will also show any abnormalities in the bone, similar to the bone scan.

After diagnostic tests are completed, your doctor will review all of the results with you. These results also help the doctor describe the amount of cancer in the body. This is called staging. If there are suspicious areas found outside of the breast, at least 1 area may be biopsied if possible to confirm the diagnosis of cancer.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.