Management of Granulomatous Lobular Mastitis and Risk Factors Associated with Recurrence

Tian, Chunxiang; Han, Xiao; Liu, Zeyu; Lv, Xinlin; Ning, Ping

doi:10.1007/s00268-022-06687-7

Cited by 5 publications

(3 citation statements)

References 53 publications

(80 reference statements)

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“…In reviewing reports on risk factors for GLM recurrence in domestic and international studies, [19][20][21][22][23][24] nipple discharge, skin damage, surgery, breast abscess, and smoking history were commonly identified as independent risk factors for unilateral recurrence (Table 4). This study found statistical differences in 4 variables: fertility, nipple development, CD4 absolute value, and CD4/CD8 ratio, through univariate analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and risk factors of bilateral granulomatous lobular mastitis

Ge,

Sun,

Feng

et al. 2024

Medicine

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Granulomatous lobular mastitis (GLM) is an idiopathic inflammatory breast disease that tends to recur on the same side. With the accumulation of clinical cases, it has been observed that GLM can also occur contralaterally. Currently, most studies on GLM focus on treatment methods and risk factors for ipsilateral recurrence, and there are few reports on bilateral GLM. The study aimed to summarize the clinical characteristics of patients with bilateral GLM by reviewing their clinical data, and to discuss the risk factors affecting the occurrence of bilateral GLM. A retrospective study of the medical records database of patients with GLM admitted between May 2019 and August 2022 was performed. Patients were divided into bilateral GLM group (bilateral GLM group) and unilateral GLM patients (unilateral GLM group). Demographic and clinical characteristics, treatment, and follow-up were collected and analyzed. In this study, by reviewing the clinical data of 59 cases of bilateral GLM, we found that the median time between the onset of bilateral GLM on both sides was 6.63 (0–18) months. Additionally, because of the simultaneous or interval onset on both sides, the duration of the disease was longer compared to unilateral cases. Regarding the history of external hospital treatment, it was found that about 57.63% of patients with bilateral GLM received 2 or more treatment modalities, with a higher involvement of herbal medicine. Meanwhile, by counting the clinical data of the 2 groups of patients with bilateral GLM and unilateral GLM, it was shown by univariate analysis that fertility, nipple development, absolute CD4 value, and CD4/CD8 ratio were associated with contralateral onset of GLM in both groups, with inverted nipple being an independent risk factor.

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Section: Discussionmentioning

confidence: 99%

Clinical features and risk factors of bilateral granulomatous lobular mastitis

Ge,

Sun,

Feng

et al. 2024

Medicine

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“…Characteristics like marital status, the use of hormonal contraceptives, a family history of breast cancer, and clinical signs such as the presence of a mass, erythema, nipple discharge, axillary lymphadenopathy, EN, and the size of the mass did not demonstrate statistically signi cant associations with the duration of the disease. Previous studies have indicated that purulent nipple discharge, skin lesions, bilateral disease, pain, a Body Mass Index (BMI) of ≥ 24 (indicative of overweight/obesity), and an elevated follicle-stimulating hormone (FSH)/luteinizing hormone (LH) ratio are associated with a heightened risk of recurrence (43)(44)(45)(46). Our ndings demonstrated that although patients experiencing pain, nipple retraction, stula drainage, and bilateral involvement tended to have a longer disease duration, these differences did not reach statistical signi cance.…”

Section: Discussionmentioning

confidence: 99%

Management of Lobular Granulomatous Mastitis; Special Focus on Treatment Challenges in Patients with Hyperprolactinemia, Erythema Nodosum, and Diabetes, and Factors Associated with a Persistent Disease Course

Rad,

Firoozi,

Sheybani

et al. 2024

Preprint

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Background This study presents our observations on the management of patients with lobular granulomatous mastitis (LGM) in a cohort study. Additionally, characteristics associated with a longer disease course, as well as treatment challenges in patients with erythema nodosum, diabetes, and hyperprolactinemia would be discussed. Methods From 2015 to 2021, a total of 246 consecutive LGM patients referred to Ghaem teaching hospital, Mashhad, Iran, were treated and followed up every three months until complete symptom resolution. Treatment responses were categorized into five groups: complete resolution, incomplete resolution, resolution with subsequent relapse, no significant improvement, and treatment cessation. Telephone follow-ups were conducted with all patients at the end of the study in December 2022. The primary outcome was the response to treatment with prednisone or methotrexate (MTX). The secondary outcome was response to treatment by the last telephone follow-up. Results Among the initial 246 patients, 90 were excluded, and a total of 156 episodes were analyzed. Prednisone was administered to 136 patients, while oral MTX was prescribed to 48 cases. The median age of the cohort was 33 years (interquartile range [IQR], 29–38). The primary outcomes were as follows: Of those on prednisone, 57 (41.9%) achieved complete resolution, with 15 (11%) experiencing subsequent relapse, 33 (24.3%) showing no significant improvement, and 31 (19.9%) discontinuing treatment. Among the MTX recipients, 23 (47.9%) achieved complete resolution, while one showed incomplete resolution. The secondary outcomes were complete resolution in 139 (89.1%), incomplete resolution in nine (5.8%) showed, and 8 (5.1%) cases remained symptomatic. The median disease duration was 18 months (IQR, 7–36), with a median follow-up period of five years (IQR, 4–6). Abscess formation during treatment correlated with prolonged disease duration (p < 0.04), and higher plasma prolactin levels were associated with extended disease duration (p = 0.001). However, the disease course did not significantly differ in diabetic cases or those with erythema nodosum compared to others. Conclusions Over a median follow-up of five years, approximately 90% of LGM patients achieved complete resolution within a median course of 18 months. The presence of abscesses during treatment and elevated plasma prolactin levels were linked to longer disease duration.

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“…A case-control study of 85 GLM cases emphasized that reproductive factors were the main risk factors of GLM, 11 but the sample size was relatively small. In addition, some retrospective studies surveyed the risk factors of GLM occurrence and recurrence, 12 , 13 but the lack of a control group limited the reliability of the results. Therefore, this is the first study to explore the predisposing factors of GLM using a large sample case-control design to provide effective evidence for clinical treatment and prevention.…”

Section: Discussionmentioning

confidence: 99%

Predisposing Factors for Granulomatous Lobular Mastitis: A Case-Control Study

Zeng¹,

Zhang²,

Zhao³

et al. 2023

IJWH

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Background Despite the rising incidence rate of granulomatous lobular mastitis (GLM), uncertainties persist about its etiologic and predisposing factors to guide clinical treatment and early prevention. The objective of this study is to explore the predisposing factors for GLM. Patients and methods This case-control study was conducted from 2018 to 2021 at Beijing Hospital of Traditional Chinese Medicine, Capital Medical University. Patients with GLM (cases) were matched with healthy examinees (controls) in a 1:1 ratio according to gender and living area. We analyzed their demographic features and investigated 75 factors that may be relevant to GLM using a standard questionnaire. Univariate and multivariable binary conditional logistic regression analyses were used to compare the differences between the two groups and evaluate the predisposing factors that may induce GLM. Results There were 594 female GLM patients and 594 matched controls included in the study. The average age of the cases was 32.78 years (mainly 20 to 40). The incidence was high within five years after childbirth, and lesions were mainly in the unilateral breast. Univariate and multivariable conditional logistic regression analyses obtained six relevant factors and six high-risk factors. The six relevant factors included age, marriage, emotional abnormality, high prolactin, psychiatric drug intake, and sex hormone intake. Additionally, the independent high-risk factors for GLM included gestation, nipple invagination, blunt trauma, non-iatrogenic massage, lactation disorder, and nipple discharge (odds ratio (OR)=17.378, 8.518, 4.887, 3.116, 2.522, 1.685, P <0.05). Menopause was an independent protective factor (OR=0.249, P <0.05). Conclusion The factors that increase milk and secretion production in the mammary duct are the main risk factors of GLM, especially when the nipples are invaginated. These factors can obstruct the duct and induce inflammation. Additionally, hormonal disorders, extrinsic trauma, and emotional abnormalities can accelerate the occurrence of GLM.

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Management of Granulomatous Lobular Mastitis and Risk Factors Associated with Recurrence

Cited by 5 publications

References 53 publications

Clinical features and risk factors of bilateral granulomatous lobular mastitis

Clinical features and risk factors of bilateral granulomatous lobular mastitis

Management of Lobular Granulomatous Mastitis; Special Focus on Treatment Challenges in Patients with Hyperprolactinemia, Erythema Nodosum, and Diabetes, and Factors Associated with a Persistent Disease Course

Predisposing Factors for Granulomatous Lobular Mastitis: A Case-Control Study

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