can you find data in the medical literature about the incidence of
falsely negative biopsy results in inflammatory breast cancer cases ,
ie cases where the first biopsy was negative and a second biopsy was
necessary in order to make the diagnosis

Hi - 

There are multiple ways of taking a biopsy of suspicious breast tissue
for the diagnosis of inflammatory breast disease.  The current gold
standard (assumed to be 100% sensitive) is open surgical biopsy in
which a large section of tissue is taken in surgery - it is often
combined with excision of the mass.  This technique should be
extremely sensitive (ie no false-negatives) unless inadequate tissue
is taken.  Other techniques of biopsy are much less invasive and are
usually preferred for initial studies as they have fewer complications
(cosmetic and otherwise).  These techniques are fine-needle aspiration
(FNA), core-needle biopsy, and vacuum-assisted biopsy.  As
inflammatory breast cancer accounts for only 3% of breast tumors,
biopsy techniques don't appear to have as many studies as there are
for other breast tumor types.  I could only find two studies with
numbers of cases where a FNA was used to diagnose inflammatory
carcinoma - one with a 33% sensitivity (so 66% false-negatives) and
one with 100% sensitivity (so no false-negatives).  Other pages
suggest that FNA is not highly accurate for the diagnosis of
inflammatory carcinoma, so, multiple biopsies (or a different type of
biopsy) might be needed.


One study compared the effectiveness of fine-needle aspiration (FNA)
biopsy with a biopsy from a Mammotome device (more on this in a
minute) found that FNA was only able to detect 2/6 cases of
inflammatory carcinoma whereas 6/6 cases were diagnosed by vacuum
biopsy (using the Mammotome) - unfortunately, only the abstract is
available online for this:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10668149&dopt=Abstract

Another study from a group of pathologists in Spain reported a 3/3
success rate for FNA biopsy confirmation of inflammatory breast
cancers
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8989535&dopt=Abstract

The Mammotome device is a specially designed tool for vacuum biopsying
breast masses from Ethicon.  A description of the device and a chart
showing the accuracies of various biopsy techniques (although it's
graded by words, not numbers) can be found here:
http://www.breastbiopsy.com/biopsyinfo_biopsyoptions2.jsp#compare

A teaching page (http://www.surgery.wisc.edu/wolberg/#diag_prog) for
medical students in Wisconsin contains an interpretation of a study
(not available online
http://www.surgery.wisc.edu/wolberg/br41_ref.html ) which suggests
that the following factors are important for FNA to be successful
(does not give numbers though)

1) proper training in needle placement and sampling technique; 

2) proper training in preparation of samples, especially to avoid an
artifact   that leads to a false-positive result;

3) performing a large volume of cases per operator; 

4) special training in interpretation of FNAB (being an expert in
breast histopathology is not enough)

5) the correlation of clinical findings with microscopic findings. A
specimen that is diagnostic and adequate in one setting may be
insufficient in another depending on clinical or radiographic
findings.


I hope that this answers your question - let me know if you want
further clarification.

synarchy

I think the researcher did a good job and the answer basically is that there is
not much out there on my question.

The most frequent cause of delay of diagnosis of inflammatory breast
cancer is mistaking it for infection, and treating for a period of
time with antibiotics. By definition, inflammatory breast cancer
involves the reddened area of skin, so a biopsy of that skin ought to
lead to a diagnosis in nearly all cases. If the skin is not biopsied,
then the chance of the initial biopsy missing the cancer is increased.

While there does not appear to be much information specific to
Inflammatory Breast Cancer in the medical literature regarding
false-negative rates for biopsies, I did find some statistics on the
Susan G. Komen website for breast cancer biopsy accuracy in general,
broken out by biopsy method:

http://www.komen.org/bci/abc/chap_05c.asp

CORE NEEDLE BIOPSY
Core needle biopsy (also known as cutting needle biopsy) is a method
that uses a thin, hollow needle to remove samples of tissue from the
breast. These tissue samples are then examined by a pathologist (a
doctor who specializes in the examination of tissue) to see if they
are cancerous ...false negatives can occur up to 4 percent of the time
for core needle biopsy.

FINE NEEDLE ASPIRATION
Fine needle aspiration, also known as fine needle biopsy, uses a
thinner needle than that used in core needle biopsy to remove a sample
of cells, rather than tissue, from the abnormal area of the breast.
The cells removed during FNA are then analyzed under the microscope by
a cytopathologist (a doctor who specializes in examining individual
cells). Because cytopathologists are specialists who are not available
to many hospitals, the need for a cytopathologist to analyze the cells
removed by FNA is an important limitation of the procedure ...FNA
[which is recommended only for palpable masses, i.e. the lump can be
physically felt, rather than only showing up on a mammogram] may not
remove enough cells for the cytopathologist to be able to make an
accurate diagnosis. This can happen about 4 percent to 13 percent of
the time (Harris et al., 2000). In addition, false negatives occur in
about 0 to 4 percent of FNA procedures performed on palpable lesions.

(my comment added here) My husband, who is a Pathologist specializing
in Cytopathology, says that while FNA is a diagnostic tool far
superior to Core Needle Biopsy, he cannot emphasize enough how
CRITICAL it is for the person doing the FNA to be VERY experienced at
FNAs; otherwise, inadequate samples or inaccurate reading of the
samples is a frequent result.

EXCISIONAL BIOPSY
Excisional biopsy is the most accurate method for diagnosing breast
cancer. Unlike the needle biopsies that take samples from a particular
area, excisional biopsy is a surgical procedure that removes the
entire suspected area (plus some surrounding normal tissue) from the
breast. It is sometimes also referred to as "lumpectomy" or "partial
mastectomy." ...There are very few false negative results...

INCISIONAL BIOPSY
Incisional biopsy is a surgical procedure where only a portion of a
tumor is removed. This procedure is done most often on women with
advanced stage cancer whose tumors are too large to be removed as an
initial treatment ... (my comment added here) since this procedure is
usually only done when the physician KNOWS cancer is present, there
are very few -- if any -- false negative results.

Hope you find this information to be of some assistance.

Hi,

Most of the techniques described above won't work with IBC. In most
cases there is no lump. Nothing to probe with a needle to remove cells
for diagnosis. The lymphatic system in the skin is involved not the
ducts as in "regular" breast cancer. It's usually diagnosed and
treated as an infection because of the inflammation and rash. The most
common symptom is dimpling - "peau d orange" since the skin on the
breast in the affected area resembles the skin of an orange. Incision
is highly NOT recommended since it generally causes the aggressive
cells to spread faster to other organs. There are treatments but it is
imperative to catch and treat this type of breast cancer as early as
possible. A biopsy of the skin area is normally done and there is a
very high rate of accuracy... if the affected area is tested.

http://www.ibcresearch.org/
is the site of a group that can help. If you think you may have this
type of breast cancer - contact them by email or phone them. That's
why there are there and they can help.

Good luck,
bcguide-ga

Hello - bcguide, I'm afraid that you are mistaken - inflammatory
breast cancer is diagnosed with the techniques listed above, as can be
demonstrated in the links from the medical literature listed above. 
You are correct that inflammatory breast cancer does not have a
prominent mass like many other kinds of cancer - this, however, does
not preclude biopsy of a suspected area (including, as you mention,
the 'peu d'orange' areas).

synarchy