What predicts the recurrence in ıdiopathic granulomatous mastitis?

Idiopathic granulomatous mastitis: TNFi effectivity in a retrospective inception cohort

OBJECTIVES

Idiopathic granulomatous mastitis is a rare, chronic, inflammatory breast disease that can mimic breast carcinoma. Histologicaly there are giant cells and epitheloid histiocytes forming non-caseating granulomas. Corticosteroids, methotrexate, azathioprine, intralesional corticosteroid injection can be used as the first step drugs in the treatment of patients with Idiopathic granulomatous mastitis, but the next step is unclear in a group of patients who are resistant to these treatments. Many of these patients also undergo unnecessary surgical interventions. Tumor necrosis factor-alpha (TNF-α) plays a role in maintaining the granuloma structure. There is few case reports and very limited data in the literature regarding TNF-α inhibitor treatment in resistant patients. Our aim is to show that TNF-α inhibitors may be an alternative for refractory patients in the treatment of idiopathic granulomatous mastitis.

METHODS

The data of 25 female patients with idiopathic granulomatous mastitis who were refractory to conventional therapies and started TNF-α inhibitors were retrospectively analyzed. Pre- and post-treatment M scores of the patients were calculated.

RESULTS

We observed that the M-scores of our patients decreased as the duration of TNF-α inhibitors use increased.

CONCLUSION

Our study contains the largest number of patients with data on the use of TNF-α inhibitors in the treatment of idiopathic granulomatous mastitis. We believe that our study will contribute to the development of idiopathic granulomatous mastitis treatment algorithms. Key Points • TNF-α inhibitors may be an alternative for refractory patients in the treatment of idiopathic granulomatous mastitis.

A new stage for predicting the prognosis of granulomatous lobular mastitis

INTRODUCTION

The prognosis of granulomatous lobular mastitis (GLM) had been poor, primarily due to the lack of a unified disease assessment standard.

OBJECTIVE

The purpose of this cohort study was to establish a staging system for GLM to more accurately evaluate the prognosis of patients.

METHODS

This study retrospectively collected data from 264 GLM patients who visited our hospital between January 2017 and December 2023. Through logistic regression analysis, factors associated with prognosis were identified, which served as the basis for creating a new staging system.

RESULTS

Univariate and multivariate logistic regression analysis revealed that hyperlipidemia (HR: 2.031; 95% CI: 1.100-3.750) and microabscesses (HR: 2.087; 95% CI = 1.138-3.827) were significant independent risk factors affecting the prognosis of GLM patients. Based on the results of logistic analysis, three different stages were ultimately established, and it was found that stage C had the highest AUC value (AUC: 0.642), followed by stage B (AUC: 0.628), with stage A (AUC: 0.614) having the lowest. The Delong test revealed no significant difference in AUC values between stage A and stage B (P =  0.255), nor between stage B and stage C (P =  0.263). However, the AUC value of the stage C was found to be higher than that of stage A (P <  0.001). Given that stage C has the highest AUC value, this study selected stage C as the final stage for evaluating the prognosis of GLM patients and named it the 1st edition of GLM stage.

CONCLUSIONS

This study constructed a rigorous and widely applicable GLM staging system (the 1st edition of GLM stage). The system demonstrated good predictive outcomes and provided strong support for clinical decision-making.

Deep Learning Models for Predicting the Recurrence of Idiopathic Granulomatous Mastitis

Background and Aim

Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory breast disease that presents significant challenges in diagnosis and treatment. Predicting the recurrence of IGM is crucial for effective patient management and improved treatment outcomes. This study aims to evaluate and compare the performance of different machine learning models, including logistic regression, random forest, and neural networks, in predicting IGM recurrence using patient data.

Methods

A retrospective analysis was conducted on 212 patients diagnosed with IGM. Collected data included comprehensive serological markers, tumor characteristics, and treatment history. The dataset was divided into a training set (70%) and a testing set (30%). Data preprocessing involved normalization, feature selection, and data augmentation to ensure model robustness. Three predictive models were developed and compared: logistic regression, random forest, and neural networks. Performance metrics such as accuracy, sensitivity, specificity, and area under the ROC curve (AUC) were used to evaluate each model's ability to predict IGM recurrence.

Results

The logistic regression model achieved an AUC of 0.837, 0.725 and 0.829 in the training cohort, validation cohort and test cohort. The random forest model showed improved performance with an AUC of 0.797, 0.755 and 0.793 in the training cohort, validation cohort and test cohort. The neural network model outperformed both the logistic regression and random forest models, with an AUC of 0.938, 0.880 and 0.913 and a better F1 score. Feature importance analysis indicated that variables such as smoking, surgery and a history of oral contraceptive use were most important in predicting recurrence.

Conclusion

This study demonstrates that, compared to logistic regression and random forest models, neural networks have superior performance in predicting the recurrence of granulomatous mastitis. The high accuracy and reliability of the neural network model highlight its potential clinical application in the early and accurate prediction of IGM recurrence.

Treatment of idiopathic granulomatous mastitis: a retrospective case series

Idiopathic granulomatous mastitis (IGM) is a rare inflammatory disease of the breast. Various clinical management approaches have been described, but their efficacy and optimal sequential order remain uncertain. We describe the first Canadian cohort of patients with IGM, discuss treatment outcomes and outline a practical management approach. This retrospective study included patients diagnosed with biopsy-confirmed IGM between 2014 and 2023, aged over 18 years. Based on a scoping review of the literature, a diagnostic and management approach was developed, and we present here the disease course and outcomes using this approach. 22 females were included, with a mean age of 40 (24-65) years, mostly presenting with a breast lump (n =22, 100%) and breast pain (n = 15, 68%). Mean rheumatology follow-up was 28.7 months (range 3-79). Mean time from first symptom to diagnosis was 3.5 months (range 1-13). Corynebacterium kroppenstedtii was found in 8 patients. Treatment including lipophilic antibiotics, corticosteroids and disease modifying anti-rheumatic drugs (DMARDs), led to complete remission in 95% of patients, in a mean time of 11.6 months (range 1-36), and relapse in only 1 patient. 11 patients required DMARDs (50%), most commonly methotrexate (n=9). We highlight the variable severity of IGM and the benefits of a severity-based treatment approach. A diligent evaluation and work-up is essential to manage IGM. The proposed severity-based management approach with medical treatment and less aggressive surgical intervention led to complete remission in 95%.

>Efficacy of disease-modifying antirheumatic drugs in the treatment of granulomatous mastitis: a systematic review

INTRODUCTION

Idiopathic granulomatous mastitis (IGM) is an inflammatory breast disorder of unknown etiology. This benign condition can mimic the clinical presentation of breast cancer and is characterized by symptoms such as breast pain, erythema, and swelling. Over the past few years, Disease-Modifying Antirheumatic Drugs (DMARDs) have been increasingly used to manage this condition. However, strong evidence to support their use is lacking.

OBJECTIVES

This systematic review aimed to summarize the evidence and evaluate the efficacy of DMARDs in the management of IGM.

METHODS

A systematic literature review, adhering to PRISMA guidelines, was conducted across electronic databases, including PubMed, EMBASE, SCOPUS, directory of open access journals (DOAJ) and Cochrane Library from their inception until May 2024. We included retrospective and prospective studies while excluding case reports and case series of less than 10 patients.

RESULTS

Eighteen studies met our eligibility criteria. Fifteen studies were retrospective, while 2 were prospective. No randomized controlled trials were identified. Of these, 16 papers examined the effect of methotrexate on IGM, revealing significant disease improvement in most cases. Several of the studies indicated that patients treated with azathioprine and mycophenolate mofetil also achieved favorable responses.

CONCLUSION

Given the rarity of IGM, only a limited number of studies have explored the use of DMARDs as a pharmacological treatment option. A significant barrier to advancing our understanding is the substantial heterogeneity in the quality and volume of data provided by these studies. Therefore, there is a need for well-designed, randomized, placebo-controlled trials to rigorously assess the efficacy of DMARDs in the treatment of IGM.

The role of tissue IgG4 levels in steroid therapy in patients with idiopathic granulomatous mastitis

Idiopathic granulomatous mastitis (IGM) is a benign, chronic inflammatory lesion of the breast. Immunoglobulin G4 (IgG4) associated disease is rare in the breast. In our study, we aimed to evaluate the efficacy of steroid treatment on IgG4 levels in tissue in patients diagnosed with IGM. Between 2008 and 2017, 55 patients diagnosed with IGM in our clinic were included in the study. Demographic, clinical, microbiologic and histopathologic characteristics, treatment modality and recovery time were evaluated retrospectively. Patients were divided into 3 groups according to tissue IgG4 levels: negative (Group I), infrequently and slightly positive (Group II), and highly positive (Group III). Group I patients had a complete response rate of 77.8%. In the rest of the patients (22.2%), insufficient response was detected from the beginning of the treatment. In Group II, the response rate was 91.3% and the permanent success rate after treatment was 87.0%. Although group III patients had a complete response at the beginning (95.65%), they relapsed in a short period of time (26.1%) after discontinuation of steroid treatment. At least one steroid-related side effect was observed in 47 (85.8%) patients in all groups. There is no consensus on the dose and duration of immunosuppressive treatment in IGM. In this study, responses to steroid treatment according to IgG4 concentration in pathologic breast tissue and recurrences after the end of treatment were determined. We think that high IgG4 concentration in the tissue is associated with recurrence and other immunosuppressive drugs should be added as maintenance after steroid treatment.

A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention

Purpose

The major aim of our meta-analysis was to review the effectiveness of various treatment modalities for achieving successful remission and preventing recurrence for women with idiopathic granulomatous mastitis (IGM). This knowledge is instrumental in developing evidence-based guidelines for clinicians to improve management strategies and outcomes for patients with IGM.

Methods

A systematic literature search was performed on MEDLINE (Ovid), Embase (Elsevier), PubMed, Cochrane Library, Web of Science, and Google Scholar; studies published to 19 January 2022 were included. A meta-analysis of 57 observational studies was performed. The results of two randomized controlled trials were also examined.

Results

There were 3,035 IGM patients across the observational and randomised studies. Overall recurrence and remission rates across all treatment strategies in 59 studies are 87.9% (2,667/3035) and 13.5% (359/2667), respectively. The studies reported 19 different treatment strategies, comprising observation, medical monotherapies, surgery, and combinations involving medical therapies, with and without surgery. Among monotherapy treatment, surgical management had the highest pooled remission rate (0.99 [95% confidence interval (CI) = 0.97-1.00]); among combination therapy, this was steroids and surgery (0.99 [0.94-1.00]). Antibiotic monotherapy had the lowest remission rate (0.72 [0.37-0.96]). The highest recurrence rates belonged to treatments that combined antibiotics and surgery (0.54 [0.02-1.00]), and antibiotics, steroids, and surgery (0.57 [0.00-1.00]). Most successful for preventing recurrence were observation (0.03 [0.00-0.10]), methotrexate (0.08 [0.00-0.24]), and steroids and surgery (0.05 [0.01-0.12]). There is a significant association between longer follow-up duration and recurrence rate reported, p = 0.002.

Conclusion

Combination therapies, especially those incorporating antibiotics, steroids, and surgery, have demonstrated higher remission rates, challenging the use of antibiotic monotherapy. There is an increased emphasis on the need for personalised, multi-pronged approach for preventing IGM recurrence, with longer follow-up care. More prospective future work in IGM research, with standardised diagnostic criteria, treatment protocols, and reporting guidelines will be important for developing treatment protocols and guidelines clinicians can adhere to in the clinical management of IGM patients.Systematic review registration: PROSPERO (CRD42022301386).

Clinical features and risk factors of bilateral granulomatous lobular mastitis

Granulomatous lobular mastitis (GLM) is an idiopathic inflammatory breast disease that tends to recur on the same side. With the accumulation of clinical cases, it has been observed that GLM can also occur contralaterally. Currently, most studies on GLM focus on treatment methods and risk factors for ipsilateral recurrence, and there are few reports on bilateral GLM. The study aimed to summarize the clinical characteristics of patients with bilateral GLM by reviewing their clinical data, and to discuss the risk factors affecting the occurrence of bilateral GLM. A retrospective study of the medical records database of patients with GLM admitted between May 2019 and August 2022 was performed. Patients were divided into bilateral GLM group (bilateral GLM group) and unilateral GLM patients (unilateral GLM group). Demographic and clinical characteristics, treatment, and follow-up were collected and analyzed. In this study, by reviewing the clinical data of 59 cases of bilateral GLM, we found that the median time between the onset of bilateral GLM on both sides was 6.63 (0-18) months. Additionally, because of the simultaneous or interval onset on both sides, the duration of the disease was longer compared to unilateral cases. Regarding the history of external hospital treatment, it was found that about 57.63% of patients with bilateral GLM received 2 or more treatment modalities, with a higher involvement of herbal medicine. Meanwhile, by counting the clinical data of the 2 groups of patients with bilateral GLM and unilateral GLM, it was shown by univariate analysis that fertility, nipple development, absolute CD4 value, and CD4/CD8 ratio were associated with contralateral onset of GLM in both groups, with inverted nipple being an independent risk factor.