Can Steroids plus Surgery Become a First-Line Treatment of Idiopathic Granulomatous Mastitis?

Abstract

Background: The aim of this study is to compare the clinical course of idiopathic granulomatous mastitis (IGM) treated with low-dose oral corticosteroid therapy alone as opposed to treatment with low-dose corticosteroid therapy followed by surgery. Patients and Methods: 37 patients were treated with an approach that consisted of methylprednisolone at a dose of 0.5 mg/kg/day followed by wide excision, and 23 patients were treated with an approach that consisted only of methylprednisolone. The treatment efficacy was compared between the two groups. Results: Clinical and radiological regression was reported in all patients with steroid therapy, and the regression rate had a median of 75% (25-100%). No recurrence was observed in patients who were treated with wide surgical excision after steroid therapy during the median follow-up period of 38 (22-78) months. The control group of 23 patients was treated only with steroid therapy, and 7 (30%) of these patients experienced recurrence in the follow-up period (p < 0.001). Conclusions: Steroid therapy was effective in the treatment of IGM by reducing the lesion size and extent. With regard to the current treatment options available for IGM, surgical excision after steroid therapy seems the better treatment option compared to steroid therapy without surgical excision. This treatment sequence reduces the rate of recurrence.

Idiopathic granulomatous mastitis: A systematic review of 3060 patients

“…The characteristic of reviewed articles is summarized in Table (). The total number of articles was 70, 59 in group A and 11 in group B.…”

“…The characteristic of reviewed articles is summarized in Table 1( [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]…”

Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study?

“…Recurrence may be observed despite broad surgical excision in IGM. The IGM recurrence rate varies between 5% and 50% according to the literature . Post‐excision recurrence may be as high as 50% .…”

Is idiopathic granulomatous mastitis a surgical disease? The jury is still out

“…There is an ongoing debate in the literature whether IGM is a surgical disease or not (6,7,10,11). The majority of the publications on the subject originate from Mediterranean countries (Turkey, Egypt) as well as countries from the Middle East (1,2,6,10,12,13).…”

“…It is commonplace among relevant literature that conservative (medical) treatment is correlated with increased rates of disease response or resolution (around 75%) but also high early disease recurrence (around 30%) (16). Around 40% of the patients under steroids develop side effects, recurrence or persistence of symptoms under steroid treatment and mandate immunosuppressive treatment (6,10,16). On the contrary, studies that included surgical resection as a firstline treatment demonstrated significantly superior results compared to steroid-alone treatment in terms of recurrence and post-treatment recovery (6 months in conservative vs. 1 month in surgery; P<0.009) (6,10).…”