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The Royal Australian and New Zealand College of Radiologists 64th Annual Scientific Meeting

Learning Objectives: To demonstrate the sonographic findings of inflammatory breast carcinoma (IBC)To illustrate the place of sonography in lesion localisation for needle biopsy of lesions in IBC. Background: Inflammatory breast cancer is a rare presentation of invasive breast carcinoma accounting for 1–2% of breast cancers. It is a very aggressive malignancy presenting either in stage III or IV disease. A retrospective review of records of 64 patients with clinical diagnosis of IBC who presented to Breast Clinic at Royal Perth Hospital from 2000–2011 was performed. Only 41 patients had initial ultrasound examination and are included in this study. Breast erythema, oedema, skin peau d’orange, rapid clinical deterioration were the criteria used in clinical diagnosis of IBC. Ultrasounds have been performed in real time grayscale with color doppler . A high – frequency linear array transducer with a central frequency of 7 MHz or greater was used. Two radiologists participated in retrospective analysis of sonographic findings. Sonographic characterization of the breast radiographic findings is in accordance with the BIRADS ultrasound lexicon. Imaging Findings: Common ultrasound findings demonstrated in this study include single or multiple masses, skin thickening, dermal lymphatic dilatation, parenchymal oedema, axillary lymphadenopathy, microcalcifications & increased vascularity. The commonest sonographic finding is the presence of skin thickening (92%). 85% of patients had single or multiple masses. Axillary lymphadenopathy has been detected in 76% of patients. Parenchymal oedema was detected in 78% of study cases. Microcalcifications although difficult to characterize with sonography,were documented in 17% of cases. Dilatation of dermal lymphatics was seen in 34% correlating with the pathological finding of dermal lymphatic invasion by tumour emboli. Multifocallity was demonstrated in 27% of cases. Ultrasound guided core biopsy or fine needle aspiration has been performed in 78% of patients in our study. Conclusion: The commonest sonographic findings in IBC are skin thickening, presence of a mass, parenchymal oedema and axillary lymphadenopathy. Dermal lymphatic dilatation, correlating with pathological finding of dermal lymphatic invasion by tumour was present in approximately 1/3 of cases. Sonography remains the preferred modality of investigation in IBC because of lack of breast compression, which is difficult in this clinical context. Ultrasound is more sensitive than mammography at detecting the primary tumour site and extent, and at demonstrating axillary adenopathy. In more than 75% sonography was used to guide needle biopsy.