American Board of Internal Medicine (ABIM) Certification Practice Exam

What imaging technique is recommended for staging patients with inflammatory breast cancer?

1. X-ray only

2. CT and bone scanning

3. Ultrasound and MRI

4. Only physical examination

The correct answer is: CT and bone scanning

Inflammatory breast cancer (IBC) is an aggressive form of breast cancer that requires accurate staging to guide treatment decisions. The correct recommendation for imaging in this case is to use both computed tomography (CT) and bone scanning. CT scans play a crucial role in evaluating the chest, abdomen, and pelvis for potential metastatic disease, helping to assess the involvement of other organs or lymph nodes. Bone scanning is particularly useful because it can detect bone metastases, which are common in advanced stages of IBC. Both imaging techniques together provide a comprehensive view of the disease's extent, aiding in determining the appropriate treatment plan. Other imaging modalities like ultrasound and MRI are also useful in certain contexts for evaluating breast lesions or assessing local disease. However, for staging purposes, particularly when seeking to identify distant metastases and the involvement of the skeletal system, CT and bone scans are the preferred standard. Physical examination alone would not provide sufficient information regarding the staging, especially in an aggressive disease like IBC. Therefore, the combination of CT and bone scanning is the optimal approach for accurately staging patients with inflammatory breast cancer.