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

Abstract

Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.

Uncommon Location of Idiopathic Granulomatous Mastitis: A Case Report

“…Moreover, our patient has a normal prolactin level, which suggests the upregulation of prolactin receptors or their hypersensitivity to prolactin in this case. 13 IGM is a self-limited disease that resolves within 2 years, but the long period of convalescence is disturbing to many patients. 11,12,18 To date, treatment options have been developed and improved in recent years.…”

“…The presence of fistula in our patient suggested an advanced disease which required treatment and thus started on corticosteroids. 13 Although steroids can be effective in nearly 80% of the cases, other patients may require alternative treatments. Immunosuppressive agents such as Methotrexate and Azathioprine are the two most common medications in unresponsive cases or patients who have developed complications due to steroids.…”

“…1 An international multidisciplinary consensus in 2021 agreed on comprehensive workup by clinicians, radiologists and pathologists and the use of history taking, physical examination, imaging and laboratory modalities to finalize the diagnosis. 13 The delay in diagnosis on average of 4-5 months is common and reported in a systematic review on 3060 cases. 14 In this case report, we present an unusual location of IGM in the accessory breast in the axilla region, which delayed the process of diagnosis.…”

Differentiation Between Granulomatous Lobular Mastitis and Breast Cancer Using Quantitative Parameters on Contrast-Enhanced Ultrasound

“…Only the most suspicious lesion fulfilling the selection criteria was evaluated when a patient had multiple lesions. GLM diagnosis criteria was based on the management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition) (8). The histopathologic results of biopsy served as the diagnosis gold standard in this study.…”

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

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After publication of this article [1], it was brought to our attention that the second author's name was incorrectly spelt. The correct name should be Shu-Yuan Xiao.

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