What predicts the recurrence in ıdiopathic granulomatous mastitis?

Lermi, Nihal; Ekin, Ali; Ocak, Tuğba; Bozkurt, Zeynep Yılmaz; Ötegeçeli, Mehmet Akif; Yağız, Burcu; Coşkun, Belkıs Nihan; Pehlivan, Yavuz; Dalkılıç, Ediz

doi:10.1007/s10067-023-06651-3

Cited by 9 publications

(3 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This association the clinical signi of abscess development as a marker disease severity and complexity. Similarly, prior has shown that the recurrence of LGM is more prevalent among those who develop recurrent abscesses during treatment (42). The prolonged illness duration with abscesses may be attributed to factors such as delayed healing and the need for additional interventions such as surgical drainage.'…”

Section: Discussionmentioning

confidence: 98%

Management of Lobular Granulomatous Mastitis; Special Focus on Treatment Challenges in Patients with Hyperprolactinemia, Erythema Nodosum, and Diabetes, and Factors Associated with a Persistent Disease Course

Rad,

Firoozi,

Sheybani

et al. 2024

Preprint

View full text Add to dashboard Cite

Background This study presents our observations on the management of patients with lobular granulomatous mastitis (LGM) in a cohort study. Additionally, characteristics associated with a longer disease course, as well as treatment challenges in patients with erythema nodosum, diabetes, and hyperprolactinemia would be discussed. Methods From 2015 to 2021, a total of 246 consecutive LGM patients referred to Ghaem teaching hospital, Mashhad, Iran, were treated and followed up every three months until complete symptom resolution. Treatment responses were categorized into five groups: complete resolution, incomplete resolution, resolution with subsequent relapse, no significant improvement, and treatment cessation. Telephone follow-ups were conducted with all patients at the end of the study in December 2022. The primary outcome was the response to treatment with prednisone or methotrexate (MTX). The secondary outcome was response to treatment by the last telephone follow-up. Results Among the initial 246 patients, 90 were excluded, and a total of 156 episodes were analyzed. Prednisone was administered to 136 patients, while oral MTX was prescribed to 48 cases. The median age of the cohort was 33 years (interquartile range [IQR], 29–38). The primary outcomes were as follows: Of those on prednisone, 57 (41.9%) achieved complete resolution, with 15 (11%) experiencing subsequent relapse, 33 (24.3%) showing no significant improvement, and 31 (19.9%) discontinuing treatment. Among the MTX recipients, 23 (47.9%) achieved complete resolution, while one showed incomplete resolution. The secondary outcomes were complete resolution in 139 (89.1%), incomplete resolution in nine (5.8%) showed, and 8 (5.1%) cases remained symptomatic. The median disease duration was 18 months (IQR, 7–36), with a median follow-up period of five years (IQR, 4–6). Abscess formation during treatment correlated with prolonged disease duration (p < 0.04), and higher plasma prolactin levels were associated with extended disease duration (p = 0.001). However, the disease course did not significantly differ in diabetic cases or those with erythema nodosum compared to others. Conclusions Over a median follow-up of five years, approximately 90% of LGM patients achieved complete resolution within a median course of 18 months. The presence of abscesses during treatment and elevated plasma prolactin levels were linked to longer disease duration.

show abstract

Section: Discussionmentioning

confidence: 98%

Management of Lobular Granulomatous Mastitis; Special Focus on Treatment Challenges in Patients with Hyperprolactinemia, Erythema Nodosum, and Diabetes, and Factors Associated with a Persistent Disease Course

Rad,

Firoozi,

Sheybani

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…Surgical treatment, including incision and drainage, wide excision, or even mastectomy, is also one of the alternative treatment options in present clinical practice ( 35 ) and has been described with varying results. A 16–66% recurrence rate after surgical treatment has been reported ( 36 - 38 ). Wide surgical excision has recently acquired acceptability for treating an increasing number of GLM cases, but extended resection to obtain clean surgical margins may cause effusion, hematoma, and breast gland abnormalities, while limited surgical methods may result in a high tendency for recurrence ( 25 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

Staged operation in the surgical treatment of granulomatous lobular mastitis

Xie,

Qu,

Feng

et al. 2024

Gland Surg

View full text Add to dashboard Cite

Background Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast condition characterized by an unclear etiology and an undefined therapeutic approach. Surgical intervention is considered an alternative modality for managing GLM. Staged operation is the predominant and characteristic surgical approach in the treatment of GLM in our center; therefore, we evaluated the efficacy of staged operative techniques in this cohort study. Methods We retrospectively reviewed 212 patients with GLM who underwent staged operation between August 2020 and July 2022 in the inpatient department of our institute. Their clinical history information, clinic complaints, treatment details, surgical outcomes, follow-up results, and scores on the satisfaction questionnaire were analyzed. The patients were called for follow-up and consultation with a deadline of August 2023. Results The median follow-up time was 27 months (range, 14–37 months). In total, 212 patients were treated with three different staged procedures according to the individual assessment and patient willingness, including 168 patients who underwent one-stage debridement operation and two-stage suture operation (DO + SO), 25 patients who underwent one-stage debridement operation without suture (DO), and 19 patients who underwent one-stage debridement and simultaneous suture operation (DSO). The median recovery time was 29 days (range, 14–60 days). A minority of patients developed postoperative complications, including effusion (1.89%), flap ischemia (0.94%), areola-nipple ischemia (0.94%) and sinus tract formation (2.36%). The scores of the satisfaction questionnaire were 43.10±3.09, and 186 patients (87.74%) gave high scores for postoperative breast appearance. Only 5 of 212 patients (2.36%) developed recurrence. Conclusions Staged operation performed in our institute is an effective and safe surgical therapy in patients with GLM, yielding a short recovery time, low recurrence and good cosmetic results.

show abstract

“…These findings underscore the need for a personalised approach to IGM treatment, considering individual patient factors, including the severity of the condition and response to initial treatments ( 85 ). Additionally, the significant heterogeneity observed in the analysis emphasises the need for further research to better understand which factors influence patients’ response to different treatment approach ( 91 – 93 ).…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention

Ong,

Ho,

Liow

et al. 2024

Front. Med.

View full text Add to dashboard Cite

PurposeThe major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM.MethodsA systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined.ResultsThere were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97–1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94–1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37–0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02–1.00]), and antibiotics, steroids, and surgery (0.57 [0.00–1.00]). Most successful for preventing recurrence were observation (0.03 [0.00–0.10]), methotrexate (0.08 [0.00–0.24]), and steroids and surgery (0.05 [0.01–0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002.ConclusionCombination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).

show abstract

What predicts the recurrence in ıdiopathic granulomatous mastitis?

Cited by 9 publications

References 47 publications

Management of Lobular Granulomatous Mastitis; Special Focus on Treatment Challenges in Patients with Hyperprolactinemia, Erythema Nodosum, and Diabetes, and Factors Associated with a Persistent Disease Course

Management of Lobular Granulomatous Mastitis; Special Focus on Treatment Challenges in Patients with Hyperprolactinemia, Erythema Nodosum, and Diabetes, and Factors Associated with a Persistent Disease Course

Staged operation in the surgical treatment of granulomatous lobular mastitis

A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention

Contact Info

Product

Resources

About