Progress in diagnosis and treatment of granulomatous lobular mastitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Yinxin , LI Zhiyu ,  CHEN Chuang ,  SUN Shengrong

Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, P. R. China;

Corresponding author：

CHEN Chuang, Email: chenc2469@163.com; SUN Shengrong, Email: sun137@sina.com

Keywords：

granulomatous lobular mastitis; etiology; diagnosis; differential diagnosis; treatment

DOI：

10.7507/1007-9424.202307060

Video：

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Objective To investigate the research progress of etiology, pathogenesis, diagnosis, differential diagnosis, and treatment of granulomatous lobular mastitis (GLM). Method A comprehensive analysis was conducted by reviewing the domestic and foreign literatures on GLM and combining with clinical experience. Results GLM was a relatively rare chronic inflammatory disease of the breast, and the number of patients had been increasing in recent years. It mainly occured in multiparous women of childbearing age. Clinically, it was characterized by a hard breast mass with or without redness and pain, and severe cases might be accompanied by nodular erythema and arthritis. Bacterial infection, especially Corynebacterium kroppenstedtii and autoimmunity were considered to be the main causes of GLM. The diagnosis of GLM needed to combine with medical history, clinical manifestations, histopathological findings, imaging findings, and laboratory tests. A multidisciplinary team for diagnosis and treatment of GLM should be established to improve the diagnostic accuracy and reduce misdiagnosis. At present, the treatment methods for GLM were mainly conservative treatment and surgical treatment, including follow-up observation, antibiotic treatment, glucocorticoid treatment, immunosuppressive therapy, surgical treatment, traditional Chinese medicine treatment, and combined treatment. Conclusions At present, the incidence of GLM is on the rise, but its etiology and pathogenesis are still unclear. The diagnosis needs to combine with many aspects, and it is recommended that the multidisciplinary team could improve the accuracy of diagnosis. There is still no unified standard for the selection and timing of treatment. Clinicians’ experience and patients’ wishes should be taken into account when choosing treatment options in clinical practice. Prospective and high-quality multicenter clinical trials and evidence-based medicine practice are still needed to further improve diagnosis and treatment of GLM.

Citation： LI Yinxin, LI Zhiyu, CHEN Chuang, SUN Shengrong. Progress in diagnosis and treatment of granulomatous lobular mastitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(12): 1514-1521. doi: 10.7507/1007-9424.202307060 Copy

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1. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol, 1972, 58(6): 642-646.
2. Liang Y, Zhan H, Krishnamurti U, et al. Further characterization of clinicopathologic features of cystic neutrophilic granulomatous mastitis. Am J Clin Pathol, 2022, 158(4): 488-493.
3. Chen W, Zhang D, Zeng Y, et al. Clinical characteristics and microbiota analysis of 44 patients with granulomatous mastitis. Front Microbiol, 2023, 14: 1175206.
4. Saydam M, Yilmaz KB, Sahin M, et al. New findings on auto-immune etiology of idiopathic granulomatous mastitis: serum IL-17, IL-22 and IL-23 levels of patients. J Invest Surg, 2021, 34(9): 993-997.
5. Dogan S, Dal F, Guler M, et al. Is peripheral blood immunophenotyping useful to understand the etiology of idiopathic granulomatous?. Hum Immunol, 2023, 84(5-7): 315-319.
6. Tang ELS, Ho CSB, Chan PMY, et al. The therapeutic dilemma of idiopathic granulomatous mastitis. Ann Acad Med Singap, 2021, 50(8): 598-605.
7. Yuan QQ, Xiao SY, Farouk O, et al. Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition). Mil Med Res, 2022, 9(1): 20.
8. Albayrak MGB, Simsek T, Kasap M, et al. Tissue proteome analysis revealed an association between cancer, immune system response, and the idiopathic granulomatous mastitis. Med Oncol, 2022, 39(12): 238.
9. Li XQ, Sun HG, Wang XH, et al. Activation of C3 and C5 may be involved in the inflammatory progression of PCM and GM. Inflammation, 2022, 45(2): 739-752.
10. Ong SS, Xu J, Sim CK, et al. Profiling microbial communities in idiopathic granulomatous mastitis. Int J Mol Sci, 2023, 24(2): 1042.
11. Yaghan RJ, Ayoub NM, Hamouri S, et al. The role of establishing a multidisciplinary team for idiopathic granulomatous mastitis in improving patient outcomes and spreading awareness about recent disease trends. Int J Breast Cancer, 2020, 2020: 5243958.
12. Li SB, Xiong Y, Han XR, et al. Pregnancy associated granulomatous mastitis: clinical characteristics, management, and outcome. Breastfeed Med, 2021, 16(9): 759-764.
13. Zuo X, Shi X, Gao X, et al. Treatment effect of mammary duct exploration combined with focal resection on granulomatous lobular mastitis. J Inflamm Res, 2021, 14: 2641-2646.
14. Tian C, Wang H, Liu Z, et al. Characteristics and management of granulomatous lobular mastitis associated with antipsychotics-induced hyperprolactinemia. Breastfeed Med, 2022, 17(7): 599-604.
15. Boldrini C. Granulomatous mastitis (GM) in a young woman with a previous history of prolactin-secreting PitNET and actual normal prolactinemia. Radiol Case Rep, 2022, 18(2): 550-555.
16. Co M, Cheng VCC, Wei J, et al. Idiopathic granulomatous mastitis: a 10-year study from a multicentre clinical database. Pathology, 2018, 50(7): 742-747.
17. Akao S, Higuchi A, Akao K, et al. Idiopathic granulomatous mastitis, erythema nodosum, and arthritis. Intern Med, 2022, 61(24): 3757-3758.
18. 曹云云, 王慧, 王冠杰, 等. 肉芽肿小叶性乳腺炎的临床特点及CDFI评分与BI-RADS分级在诊断中的应用价值. 中国超声医学杂志, 2021, 37(7): 756-760.
19. 王娟, 梁汝娜, 余珊珊, 等. 基于超声造影定量参数联合常规超声图像特征的诊断模型鉴别诊断肉芽肿性小叶性乳腺炎与早期浸润性乳腺癌的价值. 临床超声医学杂志, 2023, 25(5): 345-350.
20. Makal GB, Güvenç İ. The role of shear wave elastography in differentiating idiopathic granulomatous mastitis from breast cancer. Acad Radiol, 2021, 28(3): 339-344.
21. 莫慧端, 蔡碧琼, 王任国, 等. 超声弹性成像、钨靶摄影、MRI对肉芽肿性乳腺炎的诊断研究. 中国医疗器械信息, 2021, 27(2): 128-130.
22. Pluguez-Turull CW, Nanyes JE, Quintero CJ, et al. Idiopathic granulomatous mastitis: manifestations at multimodality imaging and pitfalls. Radiographics, 2018, 38(2): 330-356.
23. Lin Q, Fei C, Wu XY, et al. Imaging manifestations of idiopathic granulomatous lobular mastitis on cone-beam breast computed tomo-graphy. Eur J Radiol, 2022, 154: 110389.
24. Altunkeser A, Arslan FZ, Eryılmaz MA. Magnetic resonance imaging findings of idiopathic granulomatous mastitis: can it be an indirect sign of treatment success or fail?. BMC Med Imaging, 2019, 19(1): 94.
25. 陶娟, 刘园, 杨金荣, 等. 肉芽肿性乳腺炎的MRI影像特征分析. 临床放射学杂志, 2021, 40(10): 1878-1883.
26. 叶梅, 刘元英. 超声引导下空心针穿刺活检在乳腺结节良恶性鉴别诊断中的应用价值. 深圳中西医结合杂志, 2023, 33(3): 51-54.
27. 鞠仙莉, 阎红琳, 袁静萍. 肉芽肿性小叶性乳腺炎临床病理学研究进展. 中国组织化学与细胞化学杂志, 2022, 31(4): 407-411.
28. 郑碧连, 陈创, 孙圣荣. 克氏棒状杆菌感染的肉芽肿性小叶性乳腺炎患者的血象特点分析. 中华乳腺病杂志(电子版), 2022, 16(5): 284-291.
29. Huang YM, Lo C, Cheng CF, et al. Serum C-reactive protein and interleukin-6 levels as biomarkers for disease severity and clinical outcomes in patients with idiopathic granulomatous mastitis. J Clin Med, 2021, 10(10): 2077.
30. Koksal H. The clinical utility of autoantibodies in patients with idiopathic granulomatous mastitis. J Invest Surg, 2022, 35(2): 325-329.
31. Aksan H, Kundaktepe BP, Sayili U, et al. Circulating miR-155, let-7c, miR-21, and PTEN levels in differential diagnosis and prognosis of idiopathic granulomatous mastitis and breast cancer. Biofactors, 2020, 46(6): 955-962.
32. Ciftci AB, Bük ÖF, Yemez K, et al. Risk factors and the role of the albumin-to-globulin ratio in predicting recurrence among patients with idiopathic granulomatous mastitis. J Inflamm Res, 2022, 15: 5401-5412.
33. Williams MS, McClintock AH, Bourassa L, et al. Treatment of granulomatous mastitis: is there a role for antibiotics?. Eur J Breast Health, 2021, 17(3): 239-246.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Progress in diagnosis and treatment of granulomatous lobular mastitis

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