Inflammatory Breast Cancer: A Multidisciplinary Approach

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after April 6, 2023:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 3.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.00
Anatomy and Physiology: 0.25
Pathology: 0.75
Breast Interventions: 1.00

Mammography: 3.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.00
Anatomy, Physiology, and Pathology: 1.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.00

Magnetic Resonance Imaging: 1.75
Procedures: 1.75
Body: 1.75

Nuclear Medicine Technology: 1.75
Procedures: 1.75
Endocrine and Oncology Procedures: 1.75

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Thoracic Section: 3.00

Sonography: 1.75
Procedures: 1.75
Superficial Structures and Other Sonographic Procedures: 1.75

Radiation Therapy: 3.00
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 2.00
Treatment Sites and Tumors: 1.00
Prescription and Dose Calculation: 0.50
Treatments: 0.50

Outline

1. Introduction
2. Clinical Presentation
3. Differential Diagnosis
4. Differentiating Primary IBC from LABC
5. Skin Punch Biopsy
6. Role of Imaging in Diagnosis of IBC
   1. Typical Mammographic Appearance
   2. US for Pretreatment Workup
   3. MR Imaging
   4. PET/CT with ¹⁸F Fluorodeoxyglucose for Initial Staging
7. Imaging Studies to Assess Treatment Response
8. FDG PET/CT to Monitor Treatment Response
9. How Imaging Helps the Oncologist
10. How Imaging Helps the Surgeon
11. How Imaging Helps the Radiation Oncologist
12. Role of Molecular Imaging
13. Imaging for Recurrence, Restaging, and Metastases
    1. Follow-up Imaging
    2. Secondary IBC
14. Prognosis and Significance
15. Summary

Objectives

Upon completion of this course, students will:

1. know the requirements for a confirmation of IBC diagnosis
2. identify the three components of the tri-modality treatment regimen for IBC
3. recognize uses for imaging in the IBC diagnosis and treatment processes
4. recognize the common symptoms of IBC at clinical presentation
5. know the common sites for IBC metastases at clinical presentation
6. understand the term “differential diagnosis”
7. identify the key feature that differentiates IBC from non-IBC LABC
8. know the differentiators between IBC and LABC
9. know the two more proliferative intrinsic molecular subtypes of breast cancer associated with IBC
10. recognize the testing methods for HER2
11. know when HER2 testing should occur
12. be familiar with breast cancer hormone receptor status options and what this means for hormonal therapy effectiveness
13. understand how the combined under-expression of one particular gene with over-expression of another could aid in IBC formation
14. be familiar with the two genes which are over-expressed in IBC and contribute to the formation of emboli and increased metastases
15. know the layers of tissue removed with a skin punch biopsy
16. know how IBC typically appears on mammography
17. identify the uses for ultrasound imaging for IBC patients
18. be familiar with the BI-RADS® breast assessment categorization method
19. understand the uses for MR imaging for IBC patients
20. identify the most accurate imaging method for detecting IBC primary lesions
21. understand the difficulties with evaluating IBC tumor size
22. know the anatomical areas to be included in MR imaging of IBC patients
23. identify the advantages of FDG PET/CT imaging in IBC diagnosis
24. identify a possible reason for using caution with MR imaging for IBC follow up
25. be familiar with the appearance of IBC response to neoadjuvant chemotherapy on MR images
26. be familiar with the criteria for lesion and pathological lymph node measurement in RECIST evaluation via CT imaging
27. understand the RECIST 1.1 response categories
28. understand how FDG uptake is a predictor of good neoadjuvant chemotherapy response
29. understand the reasoning for preoperative chemotherapy being the standard of care for IBC patients
30. identify the uses for post-treatment imaging for IBC patients
31. understand how imaging benefits the surgeon in IBC cases
32. identify the radiation treatment fields that are often standard for IBC patients
33. be familiar with some of the different radiotracers for molecular imaging
34. identify potential uses of PET radiotracers for imaging IBC
35. know the treatment goals for patients with metastatic IBC