Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment

Yin, Yulong; Li, Xianghua; Meng, Qi; Han, Xiaogang; Zhang, Haomeng; Lv, Yonggang

doi:10.1080/08941939.2021.1894516

Cited by 49 publications

(61 citation statements)

References 95 publications

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“…No universally accepted standard treatment protocol for IGM has yet been established. 2 , 3 , 6 , 8 Reported recurrence rates in the literature are high, at up to 50%, despite the various therapeutic methods available. 7 , 9 …”

Section: Introductionmentioning

confidence: 99%

Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis

Çiftçi¹,

Bük²,

Yemez³

et al. 2022

JIR

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Background Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast with a high recurrence rate. The serum albumin to globulin ratio (AGR) is a relatively novel biomarker in inflammatory diseases, and one whose role in the recurrence of IGM remains unknown. This study primarily investigated the potential risk factors for IGM recurrence and whether AGR can be used as a predictive factor. Methods Patients diagnosed with IGM from pathology reports between 2016 and 2021 were enrolled in the study, and their medical records were analyzed retrospectively. The patients were divided into two groups – recurrence and non-recurrence. Clinical, demographic characteristics, and laboratory parameters were compared. Results Eighty-five patients were included in the study, recurrence being detected in 16 (18.8%) of these, with a median follow-up time of 39.99±18.93 months. No relationship was determined between childbearing, breastfeeding, disease severity, or therapeutic approaches and IGM recurrence. While AGR was significantly lower in the recurrence group (p < 0.001), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) results were comparable in the two groups (p = 0.472 and p = 0.421, respectively). Multivariate analysis identified low AGR (odds ratio (OR): 50.7, 95% CI 5.93–434.1 P < 0.001) and smoking (OR: 4.45, 95% CI 1.04–18.9 P = 0.044) as independent risk factors for IGM recurrence. Conclusion The study findings indicated that AGR at a cut-off value of ≤1.179 at diagnosis and smoking exhibited a remarkable performance in predicting the recurrence of IGM. Developing new risk stratification systems for IGM recurrences and using AGR in these classifications may increase the success of treatment. Trial Registration This study was registered with ClinicalTrials.gov, NCT05409586.

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Section: Introductionmentioning

confidence: 99%

Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis

Çiftçi¹,

Bük²,

Yemez³

et al. 2022

JIR

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“…For the initial assessment of this rare entity, ultrasound and mammography are commonly used imaging modalities. However, the imaging findings on ultrasound and mammography are often inconclusive, making it difficult to distinguish this disease from malignancy using these traditional imaging techniques (2,10). Dynamic contrast enhancement Magnetic resonance imaging (DCE-MRI) is a powerful tool for detecting breast disease.…”

Section: Discussionmentioning

confidence: 99%

“…Granulomatous lobular mastitis (GLM) is a rare, benign chronic inflammatory disease with unclear etiology that is frequently mistaken as a malignant process both clinically and radiographically (1) Imaging features suggestive of GLM remain nonspecific and are not always present in all patients. As a result, accurate diagnosis necessitates pathological examination (2,3). Unnecessary biopsies or surgical excision can result in chronic fistulas and breast deformities.…”

Section: Introductionmentioning

confidence: 99%

Differentiation Between Granulomatous Lobular Mastitis and Breast Cancer Using Quantitative Parameters on Contrast-Enhanced Ultrasound

et al. 2022

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ObjectiveTo investigate the Contrast-enhanced ultrasound (CEUS) imaging characteristics of granulomatous lobular mastitis (GLM) and the value of differentiating GLM from breast cancer.Materials and methodsThe study included 30 women with GLM (mean age 36.7 ± 5 years [SD]) and 58 women with breast cancer (mean age 48. ± 8 years [SD]) who were scheduled for ultrasound-guided tissue biopsy. All patients were evaluated with conventional US and CEUS prior to the biopsy. In both groups, the parameters of the quantitative and qualitative analysis of the CEUS were recorded and compared. The receiver-operating-characteristics curves (ROC) were created. Sensitivity, specificity, cut-off, and area under the curve (AUC) values were calculated.ResultsTTP values in GLM were statistically higher than in breast cancer (mean, 27.63 ± 7.29 vs. 20.10 ± 6.11), but WIS values were lower (mean, 0.16 ± 0.05 vs. 0.28 ± 0.17). Rich vascularity was discovered in 54.45% of breast cancer patients, but only 30.00% of GLM patients had rich vascularity. The AUC for the ROC test was 0.791 and 0.807, respectively. The optimal cut-off value for TTP was 24.5s, and the WIS cut-off value was 0.185dB/s, yielding 73.33% sensitivity, 84.48% specificity, and 86.21% sensitivity, 70% specificity respectively in the diagnosis of GLM. The lesion scores reduced from 4 to 3 with the addition of CEUS for the patients with GLM. However, the scores did not change for the patients with breast cancer.ConclusionCEUS could help distinguish GLM from breast cancer by detecting higher TTP and WIS values, potentially influencing clinical decision-making for additional biopsies.

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“…8 Histologically, it is characterized by the presence of mostly lobulocentric non-caseous granuloma composed of epithelioid histiocytes, multinucleated giant cells, and lymphocytes associated with neutrophilic aggregate. 9 Currently, there is no optimal treatment for IGM. Mastectomy, surgical excision, wound drainage, steroid therapy, antibiotics, and even expectant management are all considered as possible treatment approaches; however, recurrence rate may be as high as 50% even after surgical excision.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Granulomatous Mastitis: Diagnosis and Histopathologic Features, A Review

et al. 2022

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Background: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory breast condition, mostly affecting women of reproductive age within a few years of pregnancy. Due to diverse clinical and radiologic features, IGM can mimic a vast spectrum of breast conditions. Therefore, histological findings are one of the most essential bases of diagnosis. Methods: A literature search was performed to review the characteristics of IGM with an emphasis on histopathological features in English sources from 2010 to 2022. The key words used for PubMed database search were “breast”, “granulomatous mastitis”, “histopathology”, and “pathology.” Results: In total, 192 articles were retrieved, from which 38 most relevant manuscripts were selected for this review article. Conclusion: The diagnosis of IGM depends on clinical, radiologic, and pathologic findings. Palpable mass is the most frequent complaint. An irregular hypoechoic mass with varying degrees of posterior phenomena is the most common sonographic finding. Histologically, IGM is characterized by a non-caseating lobulocentric granulomatous inflammation; composed of tight aggregates of epithelioid histiocytes with or without multinucleated giant cells. At times, the presence of cystic empty vacuoles lined by neutrophils is noted that is commonly associated with cystic neutrophilic granulomatous mastitis (CNGM), a variant of IGM. Atypical findings for IGM includes: The presence of atypia and/or malignancy, caseous necrosis, marked eosinophilic infiltration, absence of granulomatous inflammation, etc.

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Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment

Cited by 49 publications

References 95 publications

Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis

Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis

Differentiation Between Granulomatous Lobular Mastitis and Breast Cancer Using Quantitative Parameters on Contrast-Enhanced Ultrasound

Idiopathic Granulomatous Mastitis: Diagnosis and Histopathologic Features, A Review

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