Division of Cancer Epidemiology and Genetics, National Cancer, Institute 6120 Executive Blvd., Rockville, Maryland, 20852-7234, USA.
Cancer Med. 2013 Apr;2(2):178-84. doi: 10.1002/cam4.48. Epub 2013 Jan 24.
The diagnosis of inflammatory breast cancer (IBC) is largely clinical and therefore inherently somewhat subjective. The objective of this study was to evaluate the diagnosis of IBC at two centers in North Africa where a higher proportion of breast cancer is diagnosed as IBC than in the United States (U.S.). Physicians prospectively enrolled suspected IBC cases at the National Cancer Institute (NCI) - Cairo, Egypt, and the Institut Salah Azaiz (ISA), Tunisia, recorded extent and duration of signs/symptoms of IBC on standardized forms, and took digital photographs of the breast. After second-level review at study hospitals, photographs and clinical information for confirmed IBC cases were reviewed by two U.S. oncologists. We calculated percent agreement between study hospital and U.S. oncologist diagnoses. Among cases confirmed by at least one U.S. oncologist, we calculated median extent and duration of signs and Spearman correlations. At least one U.S. oncologist confirmed the IBC diagnosis for 69% (39/50) of cases with photographs at the NCI-Cairo and 88% (21/24) of cases at the ISA. All confirmed cases had at least one sign of IBC (erythema, edema, peau d'orange) that covered at least one-third of the breast. The median duration of signs ranged from 1 to 3 months; extent and duration of signs were not statistically significantly correlated. From the above-mentioned outcomes, it can be concluded that the diagnosis of a substantial proportion of IBC cases is unambiguous, but a subset is difficult to distinguish from other types of locally advanced breast cancer. Among confirmed cases, the extent of signs was not related to delay in diagnosis.
炎性乳腺癌 (IBC) 的诊断主要基于临床，因此在某种程度上具有主观性。本研究的目的是评估北非两个中心的 IBC 诊断情况，这两个中心诊断出的 IBC 病例比例高于美国。医生在埃及国家癌症研究所 (NCI) 和突尼斯 Institut Salah Azaiz (ISA) 前瞻性地招募疑似 IBC 病例，在标准化表格上记录 IBC 症状/体征的程度和持续时间，并对乳房进行数字拍照。在研究医院进行二级审查后，由两位美国肿瘤学家对确诊 IBC 病例的照片和临床信息进行审查。我们计算了研究医院和美国肿瘤学家诊断之间的百分比一致性。对于至少有一位美国肿瘤学家确认的病例，我们计算了症状的中位数程度和持续时间以及斯皮尔曼相关系数。在 NCI-Cairo 有照片的病例中，至少有一位美国肿瘤学家确认了 69%（39/50）的 IBC 诊断，在 ISA 的病例中则有 88%（21/24）。所有确诊病例均至少有一种 IBC 症状（红斑、水肿、橘皮样变），至少覆盖乳房的三分之一。症状的中位数持续时间为 1 至 3 个月；症状的程度和持续时间没有统计学显著相关性。从上述结果可以得出结论，相当一部分 IBC 病例的诊断是明确的，但有一部分病例很难与其他类型的局部晚期乳腺癌区分开来。在确诊病例中，症状的程度与诊断延迟无关。
