Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients

Azizi, Armina; Prasath, Vishnu; Canner, Joseph; Gharib, Masoumeh; Fattahi, Asieh Sadat; Forghani, Maryam; Sajjadi, Samad; Farhadi, Effat; Vasigh, Mahtab; Kaviani, Ahmad; Omranipour, Ramesh; Habibi, Mehran

doi:10.1111/tbj.13822

Cited by 49 publications

(62 citation statements)

References 12 publications

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“…Although the present study showed a numerical increase of NLR in IGM patients with recurrence, NLR and serum CRP level both were essential for evaluation of inflammation. Similar to our results, skin ulcer or fistula has been identified to be a risk factor for recurrence in the previous studies [ 30 , 31 ]. Therefore, we should be alert to the skin lesion of the breast in patients with IGM.…”

Section: Discussionsupporting

confidence: 93%

Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

Huang

Cheng

et al. 2021

JCM

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Idiopathic granulomatous mastitis (IGM) is a rare inflammatory breast disease mimicking breast cancer. Limited research has been conducted on the application of serum biomarkers. This study aims to investigate the association of serum biomarkers with disease severity in patients with IGM. From November 2011 to March 2020, medical records of patients with IGM were reviewed. Serum cytokine levels were measured in patients and healthy controls between July 2018 and March 2020. A total of 41 patients with histologically proven IGM were found. Serum interleukin (IL)-6 level was significantly higher in patients with IGM (n = 11) than healthy controls (n = 7). Serum IL-6 and C-reactive protein (CRP) levels were significantly higher in patients with severe disease than mild and moderate disease. Serum IL-6 (Spearman’s ρ = 0.855; p < 0.001) and CRP (Spearman’s ρ = 0.838; p = 0.001) levels were associated with time to resolution. A higher serum CRP level was associated with a longer time to resolution (B = 0.322; p < 0.001) in multiple linear regression analysis. Serum IL-6 and CRP levels can be used as biomarkers for the evaluation of disease severity in IGM. IL-6 may play a crucial role in the immunopathology of IGM.

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Section: Discussionsupporting

confidence: 93%

Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

Huang

Cheng

et al. 2021

JCM

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“…The rate of smoking and oral contraceptive use, which are etiological factors, was 0-23.7% and 15.3%-52.6%, respectively [3,[12][13][14][15]. In our study, while smoking was 12.3% in the LC group, it was 20.4% in the OC group.…”

Section: Discussionsupporting

confidence: 38%

“…Cetinkaya et al [15] in their study, found that the duration of improvement in the observation group was 5.6 months (1.3-13.8) and 3.9 months (0.8-9.8) in the systemic steroid treatment group. Azizi et al [12] described the recovery period of the observation group as 9 months in their study. By 15 months of treatment with MTX, 75% achieved disease remission, and 13-15 (range 1-30) months were median duration of treatment [13].…”

Section: Discussionmentioning

confidence: 98%

“…In recent years, medical treatments have been more preferred in the treatment of IGM [15]. Corticosteroids have been de ned as rst-line therapy because of their positive results [12]. On the other hand, steroids are known to cause side effects that affect all systems such as blood sugar irregularity (steroid-induced diabetes mellitus), weight gain, Cushing's syndrome, and body weight gain, and as a result they require a change in treatment algorithm [11,15,[20][21][22].…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Idiopathic Granulomatous Mastitis: Combined Intralesional Steroid Injection with Topical Steroid Administration vs. Systemic (Oral) Steroid

Toktaş

Toprak

Elasan

et al. 2021

Preprint

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BackgroundIdiopathic granulomatous mastitis (IGM)is characterized by non-caseating granuloma and microabscess formation limited to mammary gland lobules. It is a form of chronic mastitis of unknown pathogenesis. In this study, we aimed to compare the effectiveness of intralesional steroid injection with topical steroids versus systemic steroid therapy in the treatment of IGM. MethodsBetween June 2017 and December 2020, the patients were collected and assessed. IGM was diagnosed histopathologically by tru-cut biopsy in patients with breast mass, pain, and erythema with suspicion of IGM. Included in the study were one hundred and eleven patients who were diagnosed with IGMand who were treated with local or oral administration of corticosteroids, with at least 6 months of follow-up. The patients were divided into 2 groups: a local corticosteroid treatment group (LC, group 1, n=57); and a peroral corticosteroid treatment group (OC, group 2, n=54). Demographic characteristics, treatment responses, recurrence rates, side effects of the steroid, and the need for surgery were compared.ResultsWhile the rate of smoking was 12.3% in the LC group, was 20.4% in the OC group. There was no history of oral contraceptive use in either group of patients. Previous steroid use was significantly lower in the LC group (10.5%) compared to the OC group (55.6%) (p = 0.001). Previous antibiotic use was significantly lower in the LC group (75.4%) compared to the OC group (100%) (p = 0.001). When complete and partial responders were grouped as “responders,” 96.5% in the LC group and 75.9% in the OC group responded after the first course of treatment (p=0.001). 98.2% in the LC group and 87.0% in the OC group were complete responders after the third course of treatment (p=0.003). While 7% of the patients in the LC group had recurrence, 37% in the OC group had recurrence (p=0.001). Steroid-related side effects were lower in the LC group (no) compared to the OC group (11.1%) (p=0.010). Surgery was performed in 3.5% of the LC group, while surgery was performed in 57.3% of the OC group (p=0.001). ConclusionSteroid injection is an IGM treatment with proven efficacy, short response time, low recurrence rate, and lower need surgery. The treatment is easy to administer and minimizes the risk of systemic side effects. Even in clinically severe cases, we believe that steroid injection might be used as monotherapy, or in combination with other therapies, to improve treatment efficacy and create a transition to less aggressive treatments.

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“…Several options have been recommended including anti-tuberculosis drugs, methotrexate, azathioprine, and surgical interventions such as drainage of the wound, wide local resection, and even mastectomy. 8,23,26,27,[31][32][33] Altıntoprak et al 23 also showed that topical steroids are effective in the treatment of IGM. Furthermore, Cetin et al 34 tion arising from the nature of the disease, expectant management seems applicable and considered feasible 35 ) with close follow-up, is also an effective alternative to aggressive treatments.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic granulomatous mastitis associated with erythema nodosum may indicate a worse prognosis

et al. 2021

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Introduction: Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease of unknown etiology, and erythema nodosum (EN) is a rare extramammary manifestation of this entity characterized by reddish, tender nodules of the lower legs. We aimed to investigate whether the association of IGM with EN has a role as a prognostic indicator. There are few case reports, and only 1 original article including 12 IGM patients with EN has been reported. Methods:We present 43 women with IGM coexisting with EN and 43 with a diagnosis of IGM only, who were randomly selected from 610 patients for a control group.To the best of our knowledge, this paper comprises the first comparative study of the coexistence of IGM and EN to be reported in the literature.Results: Our findings show that the association of IGM with EN indicates a more aggressive disease course. White blood cells, erythrocyte sedimentation rate, and C-reactive protein were significantly higher in the EN-positive group (P < .05).Arthralgia, breast feeding, fistula distribution and recurrence distributions were significantly higher in the EN-positive group (P < .05). Conclusion:Since fistula distribution and recurrence rates were higher in EN-positive group, association of IGM with EN may be an indictor of a worse prognosis. The present study highlights the importance of dermatological care. All physicians should not neglect questioning breast complaints in patients with EN since EN may be caused by IGM.

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Idiopathic granulomatous mastitis: Management and predictors of recurrence in 474 patients

Cited by 49 publications

References 12 publications

Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

Serum C-Reactive Protein and Interleukin-6 Levels as Biomarkers for Disease Severity and Clinical Outcomes in Patients with Idiopathic Granulomatous Mastitis

Treatment of Idiopathic Granulomatous Mastitis: Combined Intralesional Steroid Injection with Topical Steroid Administration vs. Systemic (Oral) Steroid

Idiopathic granulomatous mastitis associated with erythema nodosum may indicate a worse prognosis

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