An updated perspective on diagnostics and treatment of idiopathic granulomatous mastitis

Abstract

Aim: To present our experiences with the anti-inflammatory treatment of idiopathic granulomatous mastitis (IGM) and highlight the imaging and anamnestic specifics of its diagnosis. Methods: Patients with acute inflammatory breast disease underwent ultrasound examination followed by a collection of anamnestic data, and histological analysis of the process was performed using core-cut biopsy, confirming IGM. Subsequently, anti-inflammatory treatment was administered, consisting of a combination of colchicine, vitamin E, and local compresses made from an infusion of Plantago lanceolata. We also recorded any additional treatments administered extra muros prior to histological analysis (such as antibiotics, surgical intervention, and time from onset of symptoms to confirmation of dia gnosis). We analyzed the effect of the anti-inflammatory treatment administered, including the onset of improvement, adverse effects, recurrences, and duration of treatment required for symptom resolution. Results: Between 2016 and 2022, we diagnosed and histologically confirmed IGM in 53 patients through biopsy. Of these, 45 (84.9%) underwent the anti-inflammatory treatment we proposed, while eight (15.1%) opted for a different form of therapy. Currently, 27 patients (60%) are without treatment and clinical manifestations. The average duration of treatment was 34 months, and improvement in the clinical condition was observed within 2–8 weeks (average of 3 months). Four patients (14.81%) reported dyspepsia as an adverse effect. Recurrence occurred in five patients (18.52%) after 1–36 months (average of 7 months). Patients (22, 81.48%) who completed the treatment are without difficulties for 3–70 months (average of 34 months). The remaining 18 patients (40%) are currently undergoing treatment, lasting 3–41 months (average of 19 months). Conclusion: Anti-inflammatory treatment with colchicine, along with supportive therapy (compresses made from an infusion of Plantago lanceolata and vitamin E), represents a promising trend in the therapy of IGM, with minimal adverse effects. Key words: mastitis – idiopathic granulomatous mastitis – breast ultrasound – core cut biopsy – anti-inflamatory treatment