Classification of Inflammatory Breast Disorders and Step by Step Diagnosis

Abstract

In this study, the authors proposed a classification of inflammatory breast disorders based on which a practical systematic scheme in diagnosis was applied aiming to differentiate simple forms of mastitis from more complicated and malignant forms. The study population included 197 female patients who were clinically or pathologically diagnosed as having mastitis. All patients underwent Ultrasound examination. Mammography was performed for 133/197 cases. Cases of simple mastitis and periductal mastitis were followed up to ensure complete resolution. Abscess cavities and postoperative collections were drained. Other cases were biopsied to confirm diagnosis and were managed accordingly by their treating physicians. Statistical analysis was performed by the Statistical Package for Social Science. Nominal Data were expressed as frequency and relative frequencies (percentage). Ultrasound and Mammography categorical results were compared using the Pearson Chi Square and Fisher's exact test. Patients were classified into three groups; infectious, noninfectious and malignant mastitis. Simple and malignant forms of mastitis showed many signs in common. The presence of ill defined collections and abscess cavities on ultrasound favored simple over malignant forms of mastitis while extensive skin thickening and infiltrated malignant nodes favored malignant forms. Interstitial edema, edematous fat lobules, abscess cavities, skin thickening seen on ultrasound examination were significantly lower in noninfectious than simple and malignant mastitis. Mammography signs were less discriminating. Diffuse skin thickening and increased density favored malignant mastitis while dilated retro areolar ducts and characteristic calcification patterns favored noninfectious forms. Simple mastitis showed nonspecific signs. Ultrasound examination in mastitis cases shows more specific signs in differentiating between the three forms of mastitis and is useful in monitoring treatment, excluding complications and guide for interventional procedures. Mammography should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected.

Radiological and clinical features of adult non-puerperal mastitis

“…The incidence of non-puerperal mastitis, which is clinically reported as currently increasing but ,10%, is lower than that of puerperal mastitis [1,2]. Nonpuerperal mastitis is not a single specific histopathological entity but includes a wide spectrum of different disorders [2][3][4][5][6].…”

“…Nonpuerperal mastitis is not a single specific histopathological entity but includes a wide spectrum of different disorders [2][3][4][5][6]. The most frequently used classification subtypes are subareolar abscess of the breast, mastitis complicating fibrocystic disease, inflammation of a cyst and plasma cell mastitis [10,20].…”

“…The aetiology of this disease is still unknown, but it may or may not be accompanied by infection [1,2]. Non-puerperal mastitis includes a wide spectrum of different disorders, such as newborn mastitis, thelitis in young females, bacterial infections, non-bacterial infections that generally originate from deeper milk ducts (such as plasma cell mastitis and granulomatous mastitis), as well as inflammatory disorders of the breast skin [2][3][4][5][6]. The majority of patients with non-puerperal mastitis usually exhibit one or several breast masses without any other signs of inflammation.…”

Lactating breast abscess: a rare presentation of adenosquamous breast carcinoma

“…The classification of inflammatory breast disorders according to aetiology was discussed in a report by Kamal et al (12) In their study, (12) and aspiration of the subdermal lymphatics to exclude cancer. (12) In conclusion, the present case highlights that although malignancy in breast abscesses in lactating mothers is rare, it can occasionally happen.…”

Ductectasia of the Breast; An Experience With Hadfield Operation (Radical Excision of the Subareolar Duct System)

“…Furthermore, it can be very difficult to exclude malignancy and ultrasound of the breast and mammography may still miss a small proportion of cases of carcinoma of the breast. A mammogram should be performed whenever complicated, malignant and uncommon forms of mastitis are suspected (6) . The aim of the study was to evaluate the methods of the management of patients with ductectasia of the breast…”