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. 2023 Mar;105(3):218-224.
doi: 10.1308/rcsann.2022.0017. Epub 2022 May 31.

Management of idiopathic granulomatous mastitis: a prospective study

D K Sarkar  1 , R Banerjee  1 , S Gupta  2 , A K Singhal  1 , A Halder  1
Affiliations

Management of idiopathic granulomatous mastitis: a prospective study

D K Sarkar et al. Ann R Coll Surg Engl. 2023 Mar.

Abstract

Introduction: Idiopathic granulomatous mastitis (IGM) is an evolving problem with varied presentation. No definite treatment guidelines are available at present that may reduce rate of recurrence. Current evidence suggests a ductal pathology behind IGM, which leads to periductal mastitis, leakage and sinus/fistula formation. Thus, excision of the sinus/fistulous tract with en-bloc wide local excision (WLE) of the lesion could be curative. The objective of this study was to look for the basic aetiology of IGM and evaluate the effectiveness of WLE with total or partial duct excision as a curative approach.

Methods: An institutional prospective comparative study was conducted over 4 years (2015-2019), in which 59 cases of IGM were randomly divided into three groups. After necessary investigations, patients in group A received steroid therapy, those in group B received WLE and patients in group C received WLE with total or partial duct excision as the mode of treatment. Postoperative follow-up was between 6 months and 3 years.

Results: Histopathological examination (HPE) was found to be the most suitable diagnostic procedure. Patients in group B showed the highest rate of recurrence (73.6%), followed by group A (35.0%) and group C (5.0%). Patients in group C had a significantly lower chance of recurrence compared with both group A and group B (p < 0.05). HPE reports of excised ducts from patients in group C showed ductal disruption and leakage along with periductal granuloma in 70% of cases.

Conclusions: The presence of duct granuloma indicates the association of ductal pathology in IGM. IGM is therefore a disease of the mammary ducts and en-bloc duct excision is curative in non-responding cases.

Keywords: Aetiology; Duct excision; Idiopathic granulomatous mastitis; Steroid; Surgery; Wide local excision.

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Figures

Figure 1
Figure 1
Granulomatous mastitis with multiple sinus and underlying mass and the postoperative result
Figure 2
Figure 2
Granulomatous mastitis showing non-healing ulcer with underlying mass and the postoperative result
Figure 3
Figure 3
Allocation of selected patients into three treatment groups (n = 59)
Figure 4
Figure 4
Lactiferous duct showing the origin of the inflammation. The course of periductal progression leading to sinus formation is demonstrated. The dotted zone depicts the zone of curative resection.
Figure 5
Figure 5
Distribution of patients according to presenting feature (n=59) (multiple options)
Figure 6
Figure 6
Granuloma in relation to the large mammary duct
Figure 7
Figure 7
Large mammary duct infiltrated by mixed inflammatory cells
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