Imaging features of granulomatous mastitis in 36 patients with new sonographic signs

Abstract

Purpose Idiopathic granulomatous mastitis is a rare relapsing benign inflammatory breast disease with unknown etiology. Its clinical features and imaging signs may mimic inflammatory breast cancer or some other inflammatory breast disease. This may interfere with correct and timely diagnosis and thus impose an additional burden on the costs of diagnosis and therapy, as well as patient anxiety. We aimed to characterize the imaging findings of this disease and introduce two new imaging signs.Materials and methods This prospective study examined 36 patients with imaging and a clinical diagnosis of mastitis granulomatosis who were untreated and then confirmed by pathology. Demographic information, clinical data, imaging findings, and signs were recorded. Results The age range of the patients was 22-60 years with an average of 36 years. Most of the patients (78%) were at reproductive age. None of the patients had a family history of granulomatous mastitis. Most patients with granulomatous mastitis (89%) lived in regions with low socioeconomic status. For most patients, sonography indicated a heterogeneous hypoechoic mass with irregular shape and ill-defined margin (26 cases; 72.2%). Focal asymmetry (36%) and obscured mass (36%) were the most common mammographic findings. Two signs of duct ectasia containing secretion and high-flow pseudocyst appearance were described. Conclusion Mammographic and ultrasound findings can highly suggest a diagnosis of granulomatous mastitis in an appropriate clinical context.

Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition)

“…In the absence of a mass lesion, US evidence of areas of mixed echo pattern with parenchymal deformity, multiple collection pockets and tracks, focal mastitis with interstitial edema, may indicate the presence of an inflammatory granulomatous process [ 40 ]. Alikhassi et al [ 41 ] analyzed imaging features in 36 patients with GLM, 72.2% of them presented irregular, less uniform, hypoechoic masses with ill-defined margin, 50% of them formed tubular dilation and subcutaneous sinus formation, 28% of them showed floating debris, and 25% of them existed ductal ectasia.…”

You’ll see it when you know it: granulomatous mastitis

“…Skin thickening, architectural distortion, parenchymal edema, hyperemia, and ipsilateral lymphadenopathy are commonly seen (Figs. 2, 3, 4, 5, and 6) [1,2,8,12].…”

“…Given the imaging overlap between GM and other diagnoses, further imaging with mammogram may be useful. Although nonspecific, mammography demonstrates focal or regional asymmetry and/or trabecular thickening in association with one or more masses, with skin thickening, nipple retraction, and axillary lymphadenopathy [2,8,12]. The affected breast often appears larger [8] or has asymmetrically increased breast density [1].…”

“…MR findings in GM are variable, but may include heterogeneous, irregular enhancing masses, surrounding nonmass enhancement, and abscess formation. Progressive and plateau enhancement kinetics are seen [12]. Despite multimodality imaging, confirming the diagnosis of GM may require core needle biopsy.…”

Apparent diffusion coefficient magnetic resonance imaging (ADC-MRI) in the axillary breast cancer lymph node metastasis detection: a narrative review

“…However, up to 70% of clinically non-metastatic patients are found to be free from malignant axillary disease at dissection and, furthermore, this surgical procedure may determine complications such as lymphedema, arm pain, infection, or seroma (18,19). With magnetic resonance imaging (MRI) (20,21), computed tomography (22), and ultrasonography (23)(24)(25)(26)(27)(28), the preoperative study of axillary lymph node status is limited to qualitative and quantitative features such as morphological presentation (cortical thickness, presence of fatty hilum and cortical vascular flow, enhancement patterns, presence of grouping of lymph nodes) (29)(30)(31) and measurement of nodal dimensions (maximum long-axis diameter or long/short-axis ratio). All these criteria remain controversial and unsatisfactory for differentiation between metastatic and non-metastatic lymph nodes.…”