Breast tuberculosis in East London: A 13‐year retrospective observational study

Abstract

Setting Breast tuberculosis (TB) is rare in Western Europe, and its diagnosis may be delayed through lack of awareness of presenting features. Our institution serves a large East London population with a high incidence of TB. Objective To characterize presenting features and avoidable diagnostic delay in breast TB patients. Design We conducted a 13‐year retrospective study of breast TB patients treated at our institution including demographic, clinical, microbiology, and pathology data. Results Forty‐seven cases were included; 44 (94%) were female, with a median age of 33 years (IQR 28.5‐39.5). The main presenting feature was a breast lump in 41 cases (87%); which were predominantly solitary unilateral lesions (25, 61%) and frequently located in the upper outer quadrant (28, 68%). Where performed, Mycobacterium tuberculosis was cultured in 15/36 (42%) cases. Granulomata were present on biopsy or aspirate in 21 (47%) and 17 (36%) cases, respectively. The median duration between symptom onset and treatment was 20 weeks (IQR 15‐30). Forty‐six (98%) completed treatment successfully and one relapsed. Conclusion A high index of suspicion for TB is required for individuals presenting with breast symptoms from countries where TB is endemic. Development of standardized pathways may improve detection and management of breast TB may reduce diagnostic delay.

Primary Breast Tuberculosis Mimicking Carcinomatous Mastitis: A Case Report

“…In their series, Hawilo A. et al [10] noted an inflammatory or ulcerated lesion of the nipple suggesting a malignant tumor in four cases, a collected abscess in two cases and a well-limited asymptomatic nodule with benign appearance in two cases. For Emma McGuire et al [13], the most frequent clinical presentation was breast lump (87% of cases) on the upper outer quadrant in 88% of cases. This preponderance may be due to retrograde lymphatic dissemination of bacilli from the axillary lymph nodes to the adjacent upper outer breast tissue [13].…”

“…For Emma McGuire et al [13], the most frequent clinical presentation was breast lump (87% of cases) on the upper outer quadrant in 88% of cases. This preponderance may be due to retrograde lymphatic dissemination of bacilli from the axillary lymph nodes to the adjacent upper outer breast tissue [13]. Our case was similar to this clinical appearance but it was associated with inflammation of overlying skin.…”

“…Regarding laterality, tuberculous mastitis is generally unilateral without a preferential side [4]. In the study by Emma McGuire et al [13], by Hawilo A. et al…”

“…However, this eventuality is rare and Mycobacterium tuberculosis is only found in 25% of cases [3] [7]. Emma McGuire et al note that the sensitivity of breast tissue is low (3.8% and 19.5%) [13]. Surgery excision for histological examination is essential for the diagnosis [3] [12].…”

“…On histological examination, granulomatous necrotic inflammation is a characteristic of tuberculosis infection. It is necessary to eliminate differential diagnosis such as infectious and non-infectious breast pathologies [13]. The diagnosis is confirmed by the classic appearance of epithelioid granuloma with caseous necrosis [3].…”