Breast Tuberculosis in Women: A Systematic Review

Abstract

Breast tuberculosis (TB) is rarely reported and poorly described. This review aims to update the existing literature on risk factors, clinical presentations, constitutional symptoms, diagnostic procedures, and medical and surgical treatments for breast TB. In all, 1,478 cases of breast TB were collected. Previous history of TB was reported in 19% of cases. The most common clinical appearance of the lesion was breast lump (75%). The most common associated finding was axillary lymphadenitis (33%) followed by sinus or fistula (24%). The most common symptoms were pain and fever, reported in 42% and 28% of cases, respectively. The most used diagnostic method was fine-needle aspiration cytology (32%), followed by biopsy (27%), acid-fast bacteria Ziehl-Neelsen stain (26%), culture (13%), and polymerase chain reaction (2%). These tested positive in 64%, 93%, 27%, 26%, and 58% of cases, respectively. The majority (69%) of patients received a 6month anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol). Surgery consisted of excision in 39% of cases, drainage in 23%, and mastectomy in 5%. The great majority of patients had a positive outcome. It often mimics breast cancer, which makes it difficult to diagnose. Most patients, when diagnosed in time, respond to antitubercular therapy alone.

Breast Tuberculosis-a Rare Presentation of Common Disease With Diagnostic and Therapeutic Challenge.

“…(2,5) Lactation was found positive in 7-35% in various studies and it was 21% cases in this study but pregnant or HIV patients were not found. History of TB was reported in 19% of cases of BTB in literature and in this study it was 10.5% (1,6) suggesting that history of tuberculosis should be considered during evaluating breast lump.…”

“…(12) The gold standard diagnostic test of BTB is detection of AFB by ZN staining by microscopy or by solid or liquid culture accounting for 12% positivity by ZN staining and 26% by culture is in various studies and but we found it to be 6% and 15.8% respectively due to paucibacillary samples. (6,9).…”

“…Fine needle aspiration cytology (FNAC) is the most common tissue diagnostic method with 43-73% accuracy, 28% -64% sensitive (5,6,11) Histopathological diagnosis of BTB is made by demonstration of a chronic caseous necrotizing granulomas and Langhans-type giant cells with or without the demonstration of the AFB by ZN staining from specimens obtained by core biopsy, edge biopsy or biopsy from the abscess wall. (5,13) , Histopathological evaluation is 84.4% sensitive and 78.9% specific, low specificity is due of the presence of granulomas in other diseases (6,13). We found FNAC to be 74% sensitive and 27% specific whereas histopathology was 100% sensitive and 90% specific for BTB in our study, suggesting core biopsy as a gold standard diagnostic modality instead of FNAC as gives more diagnostic yields.…”

“…8Limitations of the investigations are delayed reporting, false negativity and low sensitivity of culture in paucibacillary sample, microscopy by ZN staining not able to differentiate between other Mycobacterium species and histology in absence of caseating necrosis and AFB bacilli involves all granulomatous diseases. (6,8) Hence, diagnosis of BTB is still has to be made on clinical suspicion alone, leading to misdiagnosis and unnecessary TB treatment or poor outcomes from subtreated cases To address this issue, recently, molecular diagnosis of EPTB has been achieved by the CBNAAT test. It is a rapid , automated, cartridge-based nucleic acid amplification assay which detects only M. tuberculosis DNA (rpo B gene) within 2 hours directly from the clinical specimens and also detects rifampicin resistance but does not detect atypical mycobacteria.…”

Primary breast tuberculosis in an HIV-infected patient

“…2 In this case, the patient had no typical clinical manifestations of tuberculosis and was eventually diagnosed by Xpert MTB/RIF; therefore, it is important to remember that breast tuberculosis is still present and should be suspected particularly in PLHIV. 3,4 Differential diagnosis most often involves carcinoma of the breast but may include benign neoplasms, pyogenic abscess, fungal infection, actinomycosis, fat necrosis, and sarcoidosis. 5 Imaging examination of the breast may not distinguish between benign and malignant lesions, so biopsy of the pathological tissue is strongly recommended.…”