Tuberculous Mastitis in Females of South Punjab: A Clinicopathological Analysis of Ten Years from Pakistan

Abstract

Background and Objective: Extrapulmonary tuberculosis occurring in breast is a rare disorder in West but is still present in developing nations where tuberculosis is endemic. Tuberculous Mastitis (TM) is difficult to diagnose as it has vague clinical symptoms and insufficient radiological findings. The objective of this study was to determine the frequency of tuberculous mastitis by accessible modalities for early diagnosis. Methods: After the Institutional Ethical Board approvals, Pathology laboratory archives and medical records of 5000 patients from Ibn-e-Sina Hospital Research Institute, Multan and Multi Test Laboratory, were retrieved from the year 2008 to 2018. A retrospective analysis of fine needle aspiration cytology (FNAC) results of patients who presented with breast lumps was carried out. The interpretation of cytological findings and Ziehl Neelsen stained smears was carried out by cytopathologists and microbiologists respectively. Mycobacterium DNA was detected using polymerase chain reaction (PCR) in selected cases. Results: Out of 5000 patients, tuberculosis was diagnosed in 264 (5.28%) cases on FNAC. Acid fast bacilli (AFB) positive smears were found in 79.5%patients while 20.45% cases were AFB negative. Among AFB negative smears, 38 cases were further analyzed by PCR, among which 32 (84.2%) cases showed PCR positive results for TM. An increased frequency of TM among all inflammatory breast lesions from 18% in 2008 to 47.19% in 2018 was observed. Conclusion:Tuberculous Mastitis is an uncommon form of extra-pulmonary tuberculosis. It has nonspecific clinical, radiological and varied histological findings that often mimic breast abscess or carcinoma. FNAC is essential to guide the patient to further tests including histochemistry and PCR that can be used as more sensitive and time effective detection modalities.