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Esmaeil NK, Salih AM, Pshtiwan LR, Muhialdeen AS, Abdullah AM, Hama JI, Hammood ZD, Kakamad FH, Tahir SH, Abdalla BA, Salih KM, Mohammed SH. Management of Idiopathic Granulomatous Mastitis: A Single Institution Experience. Breast Care (Basel) 2023; 18:231-238. [PMID: 37766742 PMCID: PMC10521250 DOI: 10.1159/000529647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/08/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence. Method This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started. Results Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BIRADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm2), skin thickening, and white blood cell count enhanced the chance of recurrence. Conclusion Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence.
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Affiliation(s)
- Nawzad Khaleil Esmaeil
- Department of Medical Laboratory Technology, Kalar Technical College, Sulaimani Polytechnic University, Sulaimani, Iraq
| | - Abdulwahid M. Salih
- Smart Health Tower, Sulaimani, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | | | - Aso S. Muhialdeen
- Smart Health Tower, Sulaimani, Iraq
- Kscien Organization, Azadi Mall, Sulaimani, Iraq
| | | | - Jihad Ibrahim Hama
- Department of Scientific Affairs, Research Center, University of Halabja, Halabja, Iraq
| | | | - Fahmi H. Kakamad
- Smart Health Tower, Sulaimani, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq
- Kscien Organization, Azadi Mall, Sulaimani, Iraq
| | - Soran H. Tahir
- Smart Health Tower, Sulaimani, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Berun A. Abdalla
- Smart Health Tower, Sulaimani, Iraq
- Kscien Organization, Azadi Mall, Sulaimani, Iraq
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Jiao Y, Chang K, Jiang Y, Zhang J. Identification of periductal mastitis and granulomatous lobular mastitis: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:158. [PMID: 36846004 PMCID: PMC9951018 DOI: 10.21037/atm-22-6473] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/13/2023] [Indexed: 02/07/2023]
Abstract
Background and Objective Non-puerperal mastitis (NPM) is a breast disease with poor clinical manifestations, which seriously affects women's health and quality of life. Due to the low incidence rate of the disease and the paucity of related research, there is much misdiagnosis and mis-management of periductal mastitis (PDM) and granulomatous lobular mastitis (GLM). Therefore, understanding the differences between PDM and GLM, in terms of etiology and clinical manifestations, is crucial for patient treatment and prognosis. At the same time, choosing different treatment methods may not achieve the best treatment effect, so the appropriate treatment method can often reduce the patient's pain and reduce the recurrence of the patient's disease. Methods The PubMed database was searched for articles published from 1 January 1990 to 16 June 2022 using the following search terms: "non-puerperal mastitis", "periductal mastitis", "granulomatous lobular mastitis", "mammary duct ectasia", "idiopathic granulomatous mastitis", "plasma cell mastitis", and "identification". The key findings of the related literatures were analyzed and summarized. Key Content and Findings We systematically described the key points in the differential diagnosis, treatment, and prognosis of PDM and GLM. The use of different animal models for research and novel drugs to treat the disease were also described in this paper. Conclusions The key points in the differentiation of the two diseases are clearly explained, and the respective treatment options and prognosis are summarized.
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Affiliation(s)
- Yangchi Jiao
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Kexin Chang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yue Jiang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Juliang Zhang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Yuan QQ, Xiao SX, Farouk O, Du YT, Sheybani F, Tan QT, Akbulut S, Cetin K, Alikhassi A, Yaghan RJ, Durur-Subasi I, Altintoprak F, Eom TI, Alper F, Hasbahceci M, Martínez-Ramos D, Oztekin PS, Kwong A, Pluguez-Turull CW, Brownson KE, Chandanwale S, Habibi M, Lan LY, Zhou R, Zeng XT, Bai J, Bai JW, Chen QR, Chen X, Zha XM, Dai WJ, Dai ZJ, Feng QY, Gao QJ, Gao RF, Han BS, Hou JX, Hou W, Liao HY, Luo H, Liu ZR, Lu JH, Luo B, Ma XP, Qian J, Qin JY, Wei W, Wei G, Xu LY, Xue HC, Yang HW, Yang WG, Zhang CJ, Zhang F, Zhang GX, Zhang SK, Zhang SQ, Zhang YQ, Zhang YP, Zhang SC, Zhao DW, Zheng XM, Zheng LW, Xu GR, Zhou WB, Wu GS. Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition). Mil Med Res 2022; 9:20. [PMID: 35473758 PMCID: PMC9040252 DOI: 10.1186/s40779-022-00380-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/07/2022] [Indexed: 02/07/2023] Open
Abstract
Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
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Affiliation(s)
- Qian-Qian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Shu-Xuan Xiao
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637 USA
| | - Omar Farouk
- Department of Surgical Oncology and Breast Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Yu-Tang Du
- Department of Breast Surgery, Beijing University of Chinese Medicine, Beijing, 100700 China
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 9177899191 Iran
| | - Qing Ting Tan
- Breast Department, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Sami Akbulut
- Department of Surgery, Department of Public Health, Department of Biostatistics, Bioinformatics and Medical Informatics, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Kenan Cetin
- Department of General Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Afsaneh Alikhassi
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 1419733141 Iran
| | - Rami Jalal Yaghan
- Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University-Bahrain, Manama, 26671 Bahrain
| | - Irmak Durur-Subasi
- Department of Radiology, International Faculty of Medicine, Istanbul Medipol University, 34810 Istanbul, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Faculty of Medicine, Sakarya University, 54050 Sakarya, Turkey
| | - Tae Ik Eom
- Department of Surgery, HiU Clinic, 170, Gwongwang-ro, Paldal-gu, Suwon, 16488 Korea
| | - Fatih Alper
- Department of Radiology, Faculty of Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Mustafa Hasbahceci
- Academic Support and Education Center, Hırkai Serif District, Kececi Cesmesi Str, Doktorlar Building, B/7, 34091 Istanbul, Turkey
| | - David Martínez-Ramos
- Department of General and Digestive Surgery, Hospital General Castellon, Avda Benicassim S/N, 12812004 Castellón, Spain
| | - Pelin Seher Oztekin
- Radiology Department, Ankara Training and Research Hospital, 305018 Ankara, Turkey
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong, China; The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053 China
| | - Cedric W. Pluguez-Turull
- University of Miami Health System and Miller School of Medicine, 1475 NW 12th Avenue, Miami, FL 33136 USA
| | - Kirstyn E. Brownson
- Department of Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT 84112 USA
| | - Shirish Chandanwale
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, 603203 India
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Breast Center at Bayview Campus, 4940 Eastern Avenue, Rm. A-562, Baltimore, MD 21224 USA
| | - Liu-Yi Lan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Jiao Bai
- Department of Diagnostic Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Jun-Wen Bai
- Department of Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010110 China
| | - Qiong-Rong Chen
- Center for Pathology and Molecular Diagnostics, Wuhan University, Wuhan, 430071 China
| | - Xing Chen
- Department of General Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Xiao-Ming Zha
- The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029 China
| | - Wen-Jie Dai
- Key Laboratory of Hepatosplenic Surgery and the First Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, 150007 China
| | - Zhi-Jun Dai
- Department of Breast Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, 310003 China
| | - Qin-Yu Feng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Qing-Jun Gao
- Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 China
| | - Run-Fang Gao
- Department of General Surgery, Shanxi Provincial People’s Hospital, Taiyuan, 030012 China
| | - Bao-San Han
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092 China
| | - Jin-Xuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Wei Hou
- Department of Cardiothoracic Surgery, Zaoyang People’s Hospital, Zaoyang, 441299 Hubei China
| | - Hai-Ying Liao
- Department of Thyroid and Breast Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050004 China
| | - Hong Luo
- Department of General Surgery, Guangshan County People’s Hospital, Guangshan County, Xinxiang, 465499 Henan China
| | - Zheng-Ren Liu
- Department of Breast Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Jing-Hua Lu
- Chinese Academy of Sciences, Beijing, 100045 China
| | - Bin Luo
- Department of General Surgery, School of Clinical Medicine, Tsinghua University, Beijing Tsinghua Changgung Hospital, Beijing, 102218 China
| | - Xiao-Peng Ma
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, 230001 China
| | - Jun Qian
- Department of Thyroid Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, 650032 China
| | - Jian-Yong Qin
- Department of Oncology, Liwan Central Hospital of Guangzhou, Guangzhou, 510150 China
| | - Wei Wei
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036 Guangdong China
| | - Gang Wei
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Li-Ying Xu
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Hui-Chao Xue
- Department of General Surgery, Xinxiang Medical University First Affiliated Hospital, Xinxiang, 453100 Henan China
| | - Hua-Wei Yang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021 China
| | - Wei-Ge Yang
- Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032 China
| | - Chao-Jie Zhang
- Department of Breast and Thyroid Surgery, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, 410005 China
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013 China
| | - Guan-Xin Zhang
- Department of General Surgery, Qinghai Province People’s Hospital, Xining, 810007 China
| | - Shao-Kun Zhang
- Department of Thyroid and Breast Surgery, Qingdao Women and Children’s Hospital, Qingdao, 266000 Shandong China
| | - Shu-Qun Zhang
- Department of Oncology, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, 710004 China
| | - Ye-Qiang Zhang
- Department of Cardiothoracic Surgery, Zaoyang First People’s Hospital, Zaoyang, 441299 Hubei China
| | - Yue-Peng Zhang
- Department of Diagnostic Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Sheng-Chu Zhang
- Department of Thyroid and Breast Surgery, Yichang Central People’s Hospital, Yichang, 443003 Hubei China
| | - Dai-Wei Zhao
- Department of Thyroid Surgery, The Second Affiliated Hospital, Guizhou Medical University, Kaili, 556000 Guizhou China
| | - Xiang-Min Zheng
- Department of General Surgery, Shanghai Changzheng Hospital, Shanghai, 200003 China
| | - Le-Wei Zheng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Gao-Ran Xu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Wen-Bo Zhou
- Department of Surgery, Dongfeng General Hospital Affiliated with Hubei Medical College, Shiyan, 442001 Hubei China
| | - Gao-Song Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
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Ucar EA, Durur-Subasi I, Yilmaz KB, Arikok AT, Hekimoglu B. Quantitative perfusion parameters of benign inflammatory breast pathologies: A descriptive study. Clin Imaging 2020; 68:249-256. [PMID: 32911313 DOI: 10.1016/j.clinimag.2020.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/07/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE With this study, we evaluated the perfusion magnetic resonance imaging (MRI) features of benign inflammatory breast lesions for the first time and compared their Ktrans, Kep, Ve values and contrast kinetic curves to benign masses and invasive ductal carcinoma (IDC). MATERIALS AND METHODS Perfusion MRIs of the benign masses (n = 42), inflammatory lesions (n = 25), and IDCs (n = 16) were evaluated retrospectively in terms of Ktrans, Kep, Ve values and contrast kinetic curves and compared by the Kruskal-Wallis, Mann-Whitney U, chi-square tests statistically. Cronbach α test was used to measure intraobserver and interobserver reliability. RESULTS Mean Ktrans values were 0.052 for benign masses, 0.086 for inflammatory lesions and 0.101 for IDC (p < 0.001). Mean Kep values were 0.241 for benign masses, 0.435 for inflammatory lesions and 0.530 for IDC (p < 0.001). Mean Ve values were 0.476 for benign masses, 0.318 for inflammatory lesions and 0.310 for IDC (p = 0.067). For inflammatory and IDC lesions, Ktrans and Kep values were found to be higher and Ve values were lower than benign masses (p = 0.001 for Ktrans, p = 0.001 for Kep, p = 0.045 for Ve). There were excellent or good intra-interobserver reliabilities. For the kinetic curve pattern, most of the benign lesions showed progressive (81%), inflammatory lesions progressive (64%) and IDC lesions plateau (75%) patterns (p < 0.001). CONCLUSIONS On T1 perfusion MRI, similar to IDC lesions, inflammatory lesions demonstrate higher Ktrans and Kep and lower Ve values than benign masses. Quantitative perfusion parameters are not helpful in differentiating them from IDC lesions.
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Affiliation(s)
- Elif Ayse Ucar
- Bor Public Hospital, Clinic of Radiology, Nigde, Turkey; University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey.
| | - Irmak Durur-Subasi
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey; Istanbul Medipol University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Kerim Bora Yilmaz
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of General Surgery, Ankara, Turkey
| | - Ata Turker Arikok
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Pathology, Ankara, Turkey
| | - Baki Hekimoglu
- University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Clinic of Radiology, Ankara, Turkey
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