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258
ISSN:3030-3621
X-RAY MAMMOGRAPHY IN DIFFERENCES BETWEEN MASTITIS AND
INFLAMMATORY BREAST CANCER
Fayzullaeva Madina Bakhshullo kizi
Tashkent State Medical University
1
, Uzbekistan
Boysariyeva Marjona Ravshan kizi
Tashkent State Medical University
1
, Uzbekistan
Norboeva Munisa Orif kizi
Tashkent State Medical University
1
, Uzbekistan
Nazrullayeva Nodira Najmiddin kizi
Tashkent State Medical University
1
, Uzbekistan
Annotation:
Breast cancer is more common in women over the age of 45.
Infiltrative breast cancer accounts for 1-5% of all breast cancers. This article reviews
the diagnosis of infiltrative breast cancer, mammography and sonoscopy, and the
differential diagnosis with mastitis.
Key
words:
sonography,
x-rays,
IBC,
mastitis,
mammography,
antibioticotherapy, thickness of skin, immunohistochemistry.
Аннотация:
Рак молочной железы чаще встречается у женщин старше 45
лет. Инфильтративный рак молочной железы встречается в 1–4% случаев среди
всех опухолей данной локализации. В статье рассматриваются методы
диагностики этого заболевания с использованием маммографии и сонографии, а
также проводится дифференциальный анализ инфильтративного рака и мастита.
Ключевые слова:
рентгенография, сонография, ИРМ (инфильтративный
рак молочной железы), мастит, маммография, антибиотикотерапия, утолщение
кожи, иммуногистохимия
Annotatsiya:
Ko‘krak bezi saratoni ko‘pincha 45 yoshdan oshgan ayollarda
uchraydi. Infiltrativ ko‘krak bezi saratoni barcha ko‘krak saratoni holatlarining 1–5%
ni tashkil qiladi. Ushbu maqolada infiltrativ ko‘krak bezi saratonining diagnostikasi,
mammografiya va sonografiya usullari, shuningdek, mastit bilan qiyosiy diagnostikasi
ko‘rib chiqiladi.
Kalit so’zlar:
sonografiya, rentgen, infiltrativ ko‘krak saratoni, mastit,
mammografiya, antibiotikoterapiya, terining qalinlashishi, immunogistologik
tekshiruv.
Ta'lim innovatsiyasi va integratsiyasi
48-son_2-to’plam_Iyul -2025
259
ISSN:3030-3621
Abstract:
Currently, breast cancer is among the most prevalent malignancies
worldwide. In 2022, 2,296,840 individuals were affected by this disease. Inflammatory
breast cancer is a rare yet highly aggressive form, accounting for 2–5% of all cases.
Our objective is to investigate the clinical, pathological, and mammographic
characteristics of this condition and to differentiate it from mastitis at Tashkent
Regional Oncology Dispensary. At the Tashkent Regional Oncology Dispensary, we
examined 1,000 non-breastfeeding women from March 4, 2024 to November 11, 2024
and 12 of them had IBC. The median age of IBC was 40 years (range 31-65).
Introduction
Inflammatory breast cancer (IBC) is a rare and fast-progressing type of epithelial
breast tumor. It accounts for 1% to 3,2% of all breast cancer cases in the Uzbekistan.
Signs of IBC may involve redness, swelling, diffuse pain on whole surface,
enlargement of one breast and breast skin that resembles an orange peel. Unique
symptoms for IBC are nipple inverted or retracted, diffusion pain across a breast, skin
thickening is usually extensive and affect a larger portion. Diagnosis of IBC is like as
mastitis, such as thickness skin, expanded lymph nodes and mammography’s picture.
Based on the date, IBC has not been studied in Uzbekistan. Our goal is to study the
diagnostic methods of infiltrative breast cancer and differentiate it from mastitis. (1)
Distribution of patients by ages (table 1)
Age of patients
pathological types
Abc (350 out of
1000)
Percentage n=35%
35-45
198
56,6%
45-55
97
27,7%
55-65
50
14,3%
65
5
1,4%
Age of patients of
malignant tumor types
Abc (650 out of
1000)
Percentage n=65%
35-45
61
9,4%
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ISSN:3030-3621
45-55
356
54,7%
55-65
184
28,3%
65
49
7,6%
Total
1000
100,0
Methods and Materials
We screened 1000 patients registered from March 2024 to November 2024 and
found 12 cases of IBC. Mammograms allow to look skin thickness, loss of fatty lymph
nodes hilum. IBC poses significant clinical challenges due to its rapid progression,
atypical presentation, and complex management requirements. Unlike most breast
cancers, IBC rarely presents as a distinct lump (3). Instead, it manifests with diffuse
swelling, redness, and warmth of the breast, resembling inflammatory conditions such
as mastitis or cellulitis. This resemblance often leads to delayed diagnosis or
misdiagnosis, as it may initially be treated as an infection rather than a malignancy.
Differential diagnosis between IBC and conditions like mastitis is a significant
challenge. Both conditions can present with similar clinical symptoms, such as: breast
swelling and redness, pain and warmth. Inflammatory breast cancer (IBC) is classified
as a T4d tumor, yet in nearly one-third of cases, it is only detected once distant
metastases have already developed. The risk of misdiagnosing IBC is considerably
high due to multiple contributing factors (2). A key challenge is the variability in
clinical and pathological manifestations; not all cases present with the same symptoms.
For example, while some patients display both breast inflammation and dermal
lymphatic invasion, others may exhibit only one of these features. Additionally, IBC
cannot be diagnosed solely through histopathological examination. Instead, its
identification depends on recognizing a distinct combination of clinical
symptoms.Nipple retraction or invasion in IBC, in mastitis milk or clear fluid and
sometimes pus, it is convenient way to avoid misdiagnosing. All non-metastatic IBC
patients underwent neoadjuvant chemotherapy (NACT) as the initial treatment,
followed by modified radical mastectomy (MRM), radiotherapy, and hormonal therapy
when necessary (2).
Distribution of patients by breast pathology (table 2)
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Table 2 showed incidence rate of patients by cancerous and non-cancerous types
of breast pathology. The most common cancers of breast is invasive ductal carcinoma
and non-cancerous type is fibroadenoma.
Result
Table 1 outlines the age features of the patients. 35-45 years patients more
suffered by non-cancerous types of breast pathology. Women between the ages of 45
and 55 have a higher risk of developing breast cancer compared to other age groups.
Nosology types
Abc (350 out of
1000)
Percentage
n=35%
1.
Fibroadenoma
211
60,3%
2.
Fibrolipoma
91
26%
3.
Mastitis
27
7.8%
4.
Lipoma
13
3,7%
5.
Phyllodes tumor
5
1,4%
6.
Atheroma
3
0,8%
Malignant tumor
Abc (650 out of
1000)
Percentage
n=65%
1.
Invasive ductal carcinoma
461
71%
2.
Invasive lobular carcinoma
151
23,2%
3.
Medullary breast cancer
17
2,6%
Inflammatory breast cancer
12
1.8%
4.
Mucinous breast carcinoma
9
1,4%
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Distribution of patients who suffered from malignant tumor of breast by
location (table 5)
Location
Right
Left
Total
Percen
tage
N=65
%
Upper outer
126
118
244
37,5%
Upper inner
53
66
119
18,3%
Lower outer
34
47
81
12,5%
Lower inner
16
14
30
4,6%
Middle
92
84
176
27,1%
Total
321
329
650
100,0
As shown in the table, breast cancer was primarily found in the left mammary
gland, particularly in the upper outer quadrant. A total of 650 patients were diagnosed
through sonography, mammography, and biopsy. Among them, 39 cases required
differential diagnosis to distinguish between infiltrative breast cancer (IBC) and
mastitis. In our study, biopsy confirmed the presence of the infiltrative type of breast
cancer in 12 cases out of these 39 patients. Mastitis was diagnosed in the remaining
patients and the patients were sent for antibacterial therapy. Patients with infiltrative
type of breast cancer were submitted to IGH testing and the following were obtained.
The patients had a median age of 40 years, with an age range of 31 to 65 years, and a
median symptom duration of 5 months. The positivity rates for estrogen receptor (ER),
progesterone receptor (PR), and human epidermal growth factor receptor 2
(HER2/neu) were 50%, 46%, and 60%, respectively. Additionally, mucinous breast
carcinoma was identified in cases of IBC in 1,4%.
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We see the radiological signs of breast cancer. We differentiated signs of breast
cancer and mastitis by skin thickening, infiltration and retraction or invasion of nipple
and also contours and structure of lymph nodes in axillary side.
Pic.1 X-mammography of patient M. 45 years old. Diagnosis by
histological: IBC in left breast
Pic.2 X-mammography of patient H. 53 years old. Diagnosis by histological:
mastitis in right breast
Discussion
The diagnosis of IBC requires pathological confirmation of invasive carcinoma
alongside specific clinical criteria. These include widespread redness, swelling
involving more than two-thirds of the breast, increased warmth, tenderness, and rapid
breast enlargement. However, in some cases, a mistake is made in the comparative
diagnosis with mastitis, since both have the same clinical course and appearance.
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Diagnosis on biopsy is somewhat difficult due to the presence of inflammation in the
tissue.
References
[1] Barkataki S, Javadekar MJ, Bradfield P, Murphy T, Witmer DD, Van Golen
KL: Inflammatory Breast Cancer: A Panoramic Overview. J Rare Dis Res Treat. (2018)
3(2): 37-43
[2] Ajay Gogia, Vinod Raina, Suryanarayan Vishnu Deo, Nootan Kumar Shukla,
Bidhu kalyan Mohanti, Daya Nand Sharma: Inflammatory Breast Cancer: a Single
Centre Analysis: Asian Pac J Cancer Prev, 15 (7), 3207-3210
[3] Massimo Cristofanilli, Naoto T.Ueno: Inflammatory Breast Cancer: An
Update: 2012
[4] Dhermain F. Radiotherapy of high-grade gliomas: Current standards and new
concepts, innovations in imaging and radiotherapy, and new therapeutic ap- proaches.
Chin J Cancer: 2014
