Ultrasound classification-guided minimally invasive rotary cutting in granulomatous lobular mastitis

Abstract

Background To summarize the clinical experience of ultrasound-guided minimally invasive surgery for granulomatous lobular mastitis (GLM), and explore the feasibility of this technique for treating GLM. Methods This retrospective study reviewed the clinical features and treatment outcome of 30 patients who were diagnosed pathologically as GLM from 2016.3 to 2019.5 in the Department of Breast Surgery, Women's and Children's Hospital, Xiamen University. These patients weretreated with ultrasound-guided Mammotome minimally invasive surgery, and we tried to classified the lesion into four distinct patterns (diffuse abscess mixed type, sheet hypoechoic type, localized abscess type, localized hypoechoic mass type) according to the sonographic findings and clinical symptoms to find out if these patterns correlated with treatment and recurrence rate. Results After a median follow-up of 12 months on average (4–42 months), 26 cases (86.7%) were cured without acute or chronic complications such as disseminated inflammation and bleeding. Post-operative bleeding occurred in 1 case, and 3 cases (10.00%) relapsed. The ultrasound classification had 0 cases of diffuse abscess mixed type, 17 cases (56.7%) of sheet hypoechoic type, 9 cases (30%) of localized abscess type, and 4 cases (13.3%) of localized hypoechoic mass type. All 3 recurrent cases were sheet hypoechoic type, which were cured after another open surgical resection and showed no recurrence during an average follow-up of 20 months (11–40 months). Conclusions In treating GLM patients with minimally invasive rotary cutting, ultrasound classification helps to select suitable patients, especially those with localized abscess and localized hypoechoic mass types with low recurrence rate, which is one of the safe and effective treatment methods.

A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention

“…The same 24 studies (42.1%) reporting treatment strategies with higher statistical power ( n ≥ 30) found the estimated recurrence rate is 0.11 [0.07–0.15] ( Figure 2B ) ( 8 , 28 – 35 , 37 , 38 , 40 – 44 , 46 – 48 , 50 , 54 , 58 , 59 , 61 ). The unadjusted estimate that includes studies with n < 30 IGM patients was only slightly higher: 0.12 [0.08–0.15].…”

“…Examining studies with treatment modalities of higher statistical power ( n ≥ 30) among the 57 observational studies, a random-effects meta-analysis of pooled data from 24 studies (42.1%) found the estimated proportion of successful remission is 0.97 [95%CI 0.92–0.99] ( Figure 2A ) ( 8 , 28 – 35 , 37 , 38 , 40 – 44 , 46 – 48 , 50 , 54 , 58 , 59 , 61 ). The level of heterogeneity between studies was high, with an I 2 statistic of 94.2% ( p het < 0.001; Figure 2A ).…”

Clinical therapeutic evaluation of vacuum sealing drainage and precise ultrasound‑guided debridement in the treatment of non‑lactational mastitis

“…2 . The procedure of the surgery was similar to that of minimally invasive rotary cutting surgery as previously reported ( 20 ). During the operation, the breadth and depth of the abscess were located by color Doppler ultrasound.…”

Clinical characteristics and therapeutic strategy of granulomatous mastitis accompanied by Corynebacterium kroppenstedtii: a retrospective cohort study

“…Godazandeh carried out a meta-analysis and reported that the combination of steroids and surgery was more effective than steroids only [ 45 ]. Additionally, most Chinese experts agreed that corticosteroid combined surgery was used as the primary treatment for GM [ 46 , 47 ]. Methotrexate is a treatment option for patients who have relapsed or who do not tolerate high-dose corticosteroid therapy [ 28 , 48 ].…”