Comparison of Conservative versus Surgical Treatment Protocols in Treating Idiopathic Granulomatous Mastitis: A Meta-Analysis

Abstract

Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign breast disease without any definitive therapeutic strategy. It is controversial whether to use conservative or surgical treatment of IGM and high-level evidence-based medicine data are lacking. The purpose of this study was to systemically evaluate the clinical effectiveness of the conservative versus surgical treatment for IGM. Methods: In this meta-analysis, we searched PubMed, EMbase, ScienceDirect, and Web of Science for comparative studies about the conservative versus surgical treatment of IGM. Two researchers independently identified reports and extracted data. We used Stata 11 for data analysis. A meta-analysis was performed to investigate the differences in the recurrence rate of conservative and surgical treatment using a random effects model. Results: A total of 10 studies involving 1,101 patients were included. The results demonstrated that there was no significant difference in the recurrence rate among patients who were treated by nonsurgical therapy and surgical treatment. No publication bias was detected. Conclusion: This meta-analysis demonstrates that both the conservative and surgical treatment approaches have appropriate efficacy in IGM treatment and relapse. Further randomized controlled trials with longer follow-up periods are required to confirm the advantages of each approach.

Cystic Neutrophilic Granulomatous Mastitis Regression with the Tumor Necrosis Factor-α Inhibitor, Adalimumab

“…While TNF-α levels have not been reported to be significantly higher in patients with IGM or CNGM, other T helper 17/IL-17-driven diseases such as psoriasis, and diseases exhibiting elevated IL-8 levels such as rheumatoid arthritis, respond to TNF-α blockade (8). Notably, treatment with adalimumab resolved our patient's CNGM symptoms without requiring prolonged antibiotic therapy or surgical management, which has high morbidity and recurrence rates (9,10). TNFalpha inhibitors are widely viewed as having a more favorable safety profile than systemic steroids, which are associated with potentially serious sequelae, including weight gain, osteoporosis, hypertension, glucose intolerance, and risk for opportunistic infection.…”

Clinical practice guidelines for diagnosis and treatment of patients with non-puerperal mastitis: Chinese Society of Breast Surgery (CSBrS) practice guideline 2021

“…[ 16 , 17 ] A meta-analysis has shown similar rates of recurrence of GLM after medical versus surgical treatment. [ 18 ] However, medical treatment is less traumatic; the panel therefore considers that oral steroid therapy can be given priority to GLM patients. Surgical treatment enables accurate pathological diagnosis and removal of affected tissue.…”

Local Steroid Treatment: An Effective Procedure for Idiopathic Granulomatous Mastitis, Including Complicated Cases

“…In contrast, the absence of recurrence in LST may indicate that the steroid suppresses active in ammation completely. Moreover, resection in IGM can cause undesired cosmetic results [8,10,28]. Due to high recurrence rates and poor cosmetic results, patients may require multiple operations and some of these patients even require mastectomy [29].…”