INFLAMMATORY CARCINOMAS OF THE BREAST - A CLINICAL, PATHOLOGICAL, OR A CLINICAL AND PATHOLOGICAL DEFINITION

Some controversy remains about the clinical or pathological definition of the different types of inflammatory breast cancer (IBC) and especi ally the diagnostic and prognostic value of dermal lymphatic involveme nt. Our purpose was to classify the different types of IBC for which d iagnosis was confirmed intraoperatively and ascertain features allowin g reliable diagnosis. We studied clinical findings, biological data, a nd treatment outcome in a series of 144 successive patients. Our resul ts suggest that there are 2 biologically different entities i.e., true IBC and pseudo-IBC. True IBC, whose course is currently fatal in all cases, can be divided into 2 sub-categories i.e., common true IBC (75. 7% of cases), in which inflammatory signs occur primarily or secondari ly, and occult true IBC (13.2% of cases). Dermal emboli have been obse rved in 61% of common true IBC, but their absence did not alter the ra pidly unfavourable outcome. Extensive lymph-node involvement, other bi ological features and survival were the same in the 2 sub-categories. Pseudo-IBC (11.1% of cases) can easily be confused with common true IB C. The biological characteristics of pseudo-IBC differ from those of t rue IBC: no dermal lymphatic involvement and little or no lymph-node i nvolvement. Despite large tumour size, outcome was particularly favour able. It is of great importance to differentiate true and pseudo-IBC, for which the treatments are different. Confirmation of true IBC requi res pathological demonstration of dermal lymphatic emboli or extensive lymph-node involvement. Occult IBC must be identified for patients pr esenting rapidly growing tumours. (C) 1995 Wiley-Liss, Inc.