Comparison of conservative therapy with steroids and surgical treatment for idiopathic granulomatous mastitis: Our clinical experience
Alper Parlakgümüş1, Sedat Yıldırım1, Filiz Bolat2, Ayşin Purbager3, Tamer Çolakoğlu1, Sedat Belli1, Akın Tarım1
1Başkent Üniversitesi Adana Uygulama ve Araştırma Hastanesi, Genel Cerrahi Anabilim Dalı, Adana, Türkiye
2Başkent Üniversitesi Adana Uygulama ve Araştırma Hastanesi, Patoloji Anabilim Dalı, Adana, Türkiye
3Başkent Üniversitesi Adana Uygulama ve Araştırma Hastanesi, Radyoloji Anabilim Dalı, Adana, Türkiye
Abstract
Purpose: To determine the clinical and demographical characteristics of patients with idiopathic granulomatous mastitis and to compare treatment methods.
Materials and Methods: Demographic characteristics, clinical, microbiological and pathological findings, imaging and treatment methods, as well as the healing time of 47 patients diagnosed with idiopathic granulomatous mastitis were retrospectively analysed.
Results: The median age of the patients was 36 (27-59) years. There were five patients with a lactation history in the last 6 months. Oral contraceptive use and nicotine abuse were seen in nine patients, respectively. Five patients had rheumatological diseases. The presence of a mass, discharge from the breast and erythematous lesions were the most frequently encountered complaints. Breast ultrasonography was performed on all patients, whereas 12 patients had mammography and 11 patients underwent magnetic resonance imaging. Hyperechogenic internal particles with intraductal debris was the most commonly encountered finding on ultrasonography, whereas asymmetric density on mammography and hyperintense peripheral irregular contrast enhancement on magnetic resonans imaging were seen. Microbiological cultures were performed on 28 patients. Six patients had a microbial infection and methicillin sensitive, coagulase negative Staphylococcus was revealed as the most frequently encountered microorganism. The diagnosis was proven by core biopsy in 29 patients and by incisional biopsy in 18 patients. Wide surgical excision was performed on 24 patients while 23 patients were treated with steroids as conservative follow-up therapy. The median duration of follow-up was 12 (1-96) months. The median healing time of 23 patients followed-up conservatively was 6 (1-12) months. Six of the 23 patients followed-up conservatively had a recurrence. There was no recurrence in the patients who underwent wide surgical excision (p=0.009).
Conclusion: As radiological findings are not specific for the differentiation of idiopathic granulomatous mastitis from malignant breast diseases, pathological and clinical evaluations play an important role in the diagnosis of idiopathic granulomatous mastitis. Surgical treatment is preferable to conservative follow-up.
Keywords: Granulomatous mastitis, diagnosis, treatment, idiopathic