Management of Idiopathic Granulomatous Mastitis Diagnosed by Core Biopsy: A Retrospective Multicenter Study

Abstract

Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic inflammatory condition of the breast, which usually mimics breast carcinoma. The aim of this study was to analyze the clinical features of IGM by identifying a more reliable diagnostic protocol, and evaluating the treatment methods and patient outcomes on follow-up. We performed a retrospective analysis of 46 patients diagnosed with IGM and managed by the same surgical team between 1999 and 2011, at three high-volume hospitals. The median age of the patients was 33 years. The most common symptom was painful breast mass (n = 39), followed by abscess (n = 11). All patients underwent ultrasonography (USG). Mammography (MG) and magnetic resonance imaging (MRI) were also performed in 20 patients (43%) and 17 patients (37%), respectively. The mean size of the lesions was 32.8 ± 8.8 mm and ranged from 15 to 50 mm. Preoperative diagnosis of IGM was established by core needle biopsy (CNB) under USG guidance. Eighteen patients (39%) underwent complete excision of the lesion and 25 (54%) were treated with steroids. Three patients treated with steroids subsequently underwent local excision. The mean follow-up period was 35.4 ± 30.9 months. Eight patients (17%) developed disease recurrence; three of these were successfully treated with steroids, one with surgery, and four with both steroids and surgery. CNB in conjunction with high diagnostic accuracy has a significant role in distinctive diagnosis of IGM and hence, is useful for treatment planning. Treatment can be designated according to the extent and the severity of the disease, and the patient's general health and treatment preferences. Patients with IGM must be closely followed up due to the frequency of disease recurrence.

Idiopathic granulomatous mastitis: diagnosis and follow-up with magnetic resonance imaging

“…We used the clinical remission to A B decide when we should start to decrease the corticosteroid dose until to clinical presentation remission, and finally to its gradual stop. Our patient did not show side effects of the steroid therapy, such as glucose intolerance and Cushingoid features 1,8 . A prospective case series demonstrated a successful treatment in the majority (90%) of women by using only the prednisone therapy 11 .…”

“…In some cases, breast abscess, fibroses and fat necrosis can occur. Reactive axillary lymphadenopathy may also be presented, as in our case report 1,5,8,10,11 . Histology is characterized by a non-caseating granulomatous inflammatory response of the breast lobules in the absence of specific underlying causes.…”

“…Other speculated causes are chemical agents, such as smoking, using drugs, trauma and use of contraceptive pills. Oran et al demonstrated that only one third in their records were smokers and 22% had a history of oral contraceptive use, therefore there is a lack of association 1,3,8 . Diagnosis is done by exclusion of cancer or other infectious diseases.…”

Mastitis. Puesta al día

“…Consiste en una zona dolorosa y de consistencia firme, que puede acompañarse de signos inflamatorios en la piel circundante y puede ulcerarse, abscesificarse o fistulizar. 42 Se debe realizar el diagnóstico diferencial con carcinoma de mama y mastitis tuberculosa.…”

Granulomatous Lobular Mastitis

“…The range of the correlation between GLM and OCS is reported as 0e42%. 22,23 In addition to AAT and OCS, a recent progress in the considerable studies is that smoking is related to the GLM, while an explicit reason has not yet been determined. Asoglu et al 24 presented that in a research with 18 GLM cases, 14 had a smoking history.…”