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. 肉芽腫小葉性乳腺炎的臨床特點及CDFI評分與BI-RADS分級在診斷中的應用價值. 中國超聲醫學雜志, 2021, 37(7): 756-760.
19. 王娟, 梁汝娜, 余珊珊, 等. 基于超聲造影定量參數聯合常規超聲圖像特征的診斷模型鑒別診斷肉芽腫性小葉性乳腺炎與早期浸潤性乳腺癌的價值. 臨床超聲醫學雜志, 2023, 25(5): 345-350.
20. Makal GB, Güven? ?. 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, 蔡碧瓊, 王任國, 等. 超聲彈性成像、鎢靶攝影、MRI對肉芽腫性乳腺炎的診斷研究. 中國醫療器械信息, 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, Ery?lmaz 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, 劉園, 楊金榮, 等. 肉芽腫性乳腺炎的MRI影像特征分析. 臨床放射學雜志, 2021, 40(10): 1878-1883.
26. 葉梅, 劉元英. 超聲引導下空心針穿刺活檢在乳腺結節良惡性鑒別診斷中的應用價值. 深圳中西醫結合雜志, 2023, 33(3): 51-54.
27. 鞠仙莉, 閻紅琳, 袁靜萍. 肉芽腫性小葉性乳腺炎臨床病理學研究進展. 中國組織化學與細胞化學雜志, 2022, 31(4): 407-411.
28. 鄭碧連, 陳創, 孫圣榮. 克氏棒狀桿菌感染的肉芽腫性小葉性乳腺炎患者的血象特點分析. 中華乳腺病雜志(電子版), 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.
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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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