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Ong SS, Ho PJ, Liow JJK, Tan QT, Goh SSN, Li J, Hartman M. A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention. Front Med (Lausanne) 2024; 11:1346790. [PMID: 38873201 PMCID: PMC11170159 DOI: 10.3389/fmed.2024.1346790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Purpose The 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. Methods A 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. Results There 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. Conclusion Combination 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).
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Affiliation(s)
- Seeu Si Ong
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Jun Kit Liow
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Qing Ting Tan
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Serene Si Ning Goh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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Idiopathic granulomatous mastitis - new approach in operative treatment. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh200914006r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Idiopathic granulomatous mastitis (GM) is described as a very
rare, non-lactating, chronic mastitis that occurs primarily in women of
childbearing age. Significant clinical problem related to GM is the
diagnostic differentiation from breast cancer. Less advanced forms of GM can
be successfully treated with limited surgical excisions and radical
treatment is recommended only for the most extensive forms. Case report.
First examination of the patient, by the surgeon at Oncology Institute of
Vojvodina was in December 2018., when initial suspicion of breast cancer was
set up. Core needle biopsy was performed and after histopathological (HP)
analysis, confirmation of GM was obtained. The patient was initially offered
Prednisone and Methotrexate therapy, which she refused and accepted only
surgical treatment. Surgical treatment was performed few weeks after needle
biopsy and consisted of performing a nipple spearing mastectomy with
excision of the orifices of all fistulous ducts and their primary sutures.
The HP findings of the operative specimen confirmed the diagnosis of GM.
While there were no signs of dieses relapse, patient was suggested secondary
reconstruction of the left breast. Twelve months after the primary
operation, secondary breast reconstruction was performed with the
interposition of a contoured silicone implant into a muscle pocket in a
standard manner. Conclusion. Nipple spearing mastectomy with secondary
breast reconstruction is aesthetically satisfactory treatment for patients
with locally advanced GM.
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Dağ A, Edizsoy A, Berkeşoğlu M. Oncoplastic Breast Surgery Techniques When Surgery is Essential for the Management of the Idiopatic Granulomatous Mastitis. J INVEST SURG 2021; 35:653-658. [PMID: 34180771 DOI: 10.1080/08941939.2021.1922552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immunosuppressive agents are the main treatment options for idiopathic granulomatous mastitis (IGM). However, in some patients, the remaining large pouch and seroma may cause recurrence and severe deformity. Oncoplastic breast surgery (OBS) techniques can be used when surgery is required. MATERIAL AND METHODS In this study, surgical results of the patients histopathologically diagnosed with IGM who underwent any of the OBS techniques between 2016 and 2020 were evaluated. Patient characteristics, surgical indications, and technical details of the surgery were recorded. RESULTS Eighteen patients who underwent wide excision combined with the OBS technique were included in the study. Surgery was performed owning to persistent disease (n = 12), recurrence (n = 3), and patient preference (n = 3). No major complications occurred after the OBS technique. None of the patients had recurrence at the surgical site. CONCLUSIONS When surgery is indicated in patients with IGM, successful results can be obtained with acceptable complication rates by using the simplest and easiest applicable OBS techniques, including volume displacement technique.
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Affiliation(s)
- Ahmet Dağ
- Faculty of Medicine, Clinic of General Surgery, Mersin University, Mersin, Turkey
| | - Akay Edizsoy
- Clinic of Surgical Oncology, Isparta City Hospital, Isparta, Turkey
| | - Mustafa Berkeşoğlu
- Faculty of Medicine, Clinic of General Surgery, Mersin University, Mersin, Turkey
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