Abstract：
OBJECTIVE: The purpose of this narrative review is to summarize the contributors to misdiagnosis or delayed diagnosis of inflammatory breast cancer (IBC) and strategies for expedient diagnosis.
BACKGROUND: Patients with IBC often report the disease as initially being misdiagnosed, most commonly as mastitis.
METHODS: We reviewed the literature on this challenging diagnosis by using sequential PubMed search criteria including IBC breast symptoms, IBC diagnosis, and IBC imaging modalities to augment the authors\' knowledge of IBC. Other references were added from the manuscripts identified in the PubMed searches and from manuscript reviewers.
CONCLUSIONS: Several factors contribute to the delayed diagnosis of IBC. One important factor is that IBC is uncommon, and many generalists may not be aware of it in the differential diagnosis of breast skin symptoms. Several features of IBC contribute to the low sensitivity of mammography for its detection, and so the diagnosis is based on clinical factors and is thereby subjective. The presentation can be highly varied; classic textbook images that do not capture the range of presenting signs and symptoms across skin tones may contribute to missed diagnoses in patients with atypical presentations. In fact, the staging system of the American Joint Committee on Cancer, which requires erythema of the breast skin for diagnosis, may exclude patients with obvious global breast skin findings that are not explicitly red. We present an adapted algorithm for working up the undiagnosed inflammatory breast to ensure the timely and accurate diagnosis of IBC. We assert that frank, non-erythematous global skin signs in an enlarged breast with diffuse breast malignancy are sufficient to diagnose IBC if the timing of these signs and findings on biopsy are consistent. We further provide images of atypical IBC identified by global breast skin signs, including peau d\'orange, consistent with IBC in the absence of frank erythema.
BACKGROUND: Patients with IBC often report the disease as initially being misdiagnosed, most commonly as mastitis.
METHODS: We reviewed the literature on this challenging diagnosis by using sequential PubMed search criteria including IBC breast symptoms, IBC diagnosis, and IBC imaging modalities to augment the authors\' knowledge of IBC. Other references were added from the manuscripts identified in the PubMed searches and from manuscript reviewers.
CONCLUSIONS: Several factors contribute to the delayed diagnosis of IBC. One important factor is that IBC is uncommon, and many generalists may not be aware of it in the differential diagnosis of breast skin symptoms. Several features of IBC contribute to the low sensitivity of mammography for its detection, and so the diagnosis is based on clinical factors and is thereby subjective. The presentation can be highly varied; classic textbook images that do not capture the range of presenting signs and symptoms across skin tones may contribute to missed diagnoses in patients with atypical presentations. In fact, the staging system of the American Joint Committee on Cancer, which requires erythema of the breast skin for diagnosis, may exclude patients with obvious global breast skin findings that are not explicitly red. We present an adapted algorithm for working up the undiagnosed inflammatory breast to ensure the timely and accurate diagnosis of IBC. We assert that frank, non-erythematous global skin signs in an enlarged breast with diffuse breast malignancy are sufficient to diagnose IBC if the timing of these signs and findings on biopsy are consistent. We further provide images of atypical IBC identified by global breast skin signs, including peau d\'orange, consistent with IBC in the absence of frank erythema.
摘要：
目的：这篇叙述性综述的目的是总结炎性乳腺癌（IBC）的误诊或延迟诊断的原因以及快速诊断的策略。
背景：IBC患者经常报告该病最初被误诊，最常见的是乳腺炎。
方法：我们通过使用序贯PubMed搜索标准（包括IBC乳腺症状）对这一具有挑战性的诊断进行了综述，IBC诊断,和IBC成像模式，以增加作者对IBC的认识。从PubMed搜索中确定的手稿和手稿审阅者中添加了其他参考文献。
结论：多种因素导致IBC的延迟诊断。一个重要因素是IBC并不常见，而许多通才在乳腺皮肤症状的鉴别诊断中可能并没有意识到这一点。IBC的一些特征导致乳房X线照相术对其检测的敏感性低，因此诊断是基于临床因素，因此是主观的。演示文稿可以是多种多样的；经典的教科书图像不能捕捉到整个肤色中出现的体征和症状的范围，可能会导致非典型演示文稿患者的漏诊。事实上,美国癌症联合委员会的分期系统，这需要乳房皮肤红斑来诊断，可能排除有明显整体乳房皮肤发现但未明确红色的患者。我们提出了一种适应的算法，用于处理未诊断的炎性乳房，以确保及时准确地诊断IBC。我们断言Frank,如果这些体征的时间和活检发现一致,则在弥漫性乳腺恶性肿瘤的增大的乳房中出现的非红斑性整体皮肤体征足以诊断IBC.我们还提供了通过全球乳房皮肤体征识别的非典型IBC的图像，包括橙色，在没有明显红斑的情况下与IBC一致。
背景：IBC患者经常报告该病最初被误诊，最常见的是乳腺炎。
方法：我们通过使用序贯PubMed搜索标准（包括IBC乳腺症状）对这一具有挑战性的诊断进行了综述，IBC诊断,和IBC成像模式，以增加作者对IBC的认识。从PubMed搜索中确定的手稿和手稿审阅者中添加了其他参考文献。
结论：多种因素导致IBC的延迟诊断。一个重要因素是IBC并不常见，而许多通才在乳腺皮肤症状的鉴别诊断中可能并没有意识到这一点。IBC的一些特征导致乳房X线照相术对其检测的敏感性低，因此诊断是基于临床因素，因此是主观的。演示文稿可以是多种多样的；经典的教科书图像不能捕捉到整个肤色中出现的体征和症状的范围，可能会导致非典型演示文稿患者的漏诊。事实上,美国癌症联合委员会的分期系统，这需要乳房皮肤红斑来诊断，可能排除有明显整体乳房皮肤发现但未明确红色的患者。我们提出了一种适应的算法，用于处理未诊断的炎性乳房，以确保及时准确地诊断IBC。我们断言Frank,如果这些体征的时间和活检发现一致,则在弥漫性乳腺恶性肿瘤的增大的乳房中出现的非红斑性整体皮肤体征足以诊断IBC.我们还提供了通过全球乳房皮肤体征识别的非典型IBC的图像，包括橙色，在没有明显红斑的情况下与IBC一致。
