1
|
Kapoor NS, Ryu H, Smith L, Zou J, Mitchell K, Blair SL. Presentation and Management of Granulomatous Mastitis in the United States: Results of an American Society of Breast Surgeons Registry Study. Ann Surg Oncol 2024:10.1245/s10434-024-15714-x. [PMID: 38969857 DOI: 10.1245/s10434-024-15714-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/16/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Granulomatous mastitis (GM) is a benign, chronic, inflammatory disease lacking clear treatment guidelines. The purpose of this American Society of Breast Surgeons (ASBrS) prospective, multisite registry was to characterize the presentation of GM and identify treatment strategies associated with symptom resolution and optimal cosmesis. METHODS ASBrS members entered data into a registry on patient demographics, treatment, symptoms, and cosmesis over a 1-year period. Initial symptoms were graded as mild, moderate, or severe. The Chi-square test and logistic regression were used to identify factors related to symptom improvement and cosmesis. RESULTS Overall, 112 patients with a mean age of 36 years were included. More patients were Hispanic (49.1%) and from the Southwest (41.1%), and management included observation (4.5%), medical (70.5%), surgical (5.4%), or combination treatment (19.6%). Immunosuppression was used in 83 patients (74.1%), including 43 patients who received intralesional steroid injections. Patients with severe symptoms were more likely to undergo surgical intervention compared with those with mild or moderate symptoms (21.4% vs. 0% and 7.5%, respectively; p = 0.004). Within 1 year, 85 patients (75.9%) experienced symptom improvement and/or resolution at a median of 3 months. Receipt of immunosuppressive therapy was predictive of improvement or resolution at 1 month (odds ratio 4.22; p = 0.045). One-year physician-assessed cosmesis was excellent or good for 20/35 patients (57.1%) and was not associated with type of treatment or symptom severity. CONCLUSION Although GM can have a protracted course, the majority of patients in this registry resolved within 1 year, with good cosmetic result. Treatment with immunosuppression appears to be most beneficial, and a symptom-based algorithm may be helpful to guide treatment.
Collapse
Affiliation(s)
- Nimmi S Kapoor
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Howon Ryu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | | | - Jingjing Zou
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Katrina Mitchell
- Department of Surgical Oncology, Ridley Tree Cancer Center, Santa Barbara, CA, USA
| | - Sarah L Blair
- Division of Breast Surgery, Department of Surgery, University of California, San Diego, CA, USA
| |
Collapse
|
2
|
Shojaeian F, Haghighat S, Abbasvandi F, Houshdar Tehrani A, Najar Najafi N, Zandi A, Olfatbakhsh A, Sharifi M, Hashemi E, Nafissi N, Najafi S. Refractory and Recurrent Idiopathic Granulomatous Mastitis Treatment: Adaptive, Randomized Clinical Trial. J Am Coll Surg 2024; 238:1153-1165. [PMID: 38372343 DOI: 10.1097/xcs.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
BACKGROUND Idiopathic granulomatous mastitis (IGM) is mostly described as an autoimmune disease with higher prevalence among Middle Eastern childbearing-age women. This study aimed to evaluate the best treatment of choice in patients with resistant or recurrent IGM. STUDY DESIGN Patients with established recurrent or resistant IGM who were referred to the Breast Cancer Research Center from 2017 to 2020 were randomly assigned to either one of the following treatment groups: A (best supportive care), B (corticosteroids: prednisolone), and C (methotrexate and low-dose corticosteroids). This adaptive clinical trial evaluated radiological and clinical responses, as well as the potential side effects, on a regular basis in each group, with patients followed up for a minimum of 2 years. RESULTS A total of 318 participants, with a mean age of 33.52 ± 6.77 years, were divided into groups A (10 patients), B (78 patients), and C (230 patients). In group A, no therapeutic response was observed; group B exhibited a mixed response, with 14.1% experiencing complete or partial responses, 7.7% maintaining stability, and 78.2% experiencing disease progression. Accordingly, groups A and B were terminated due to inadequate response. In group C, 94.3% achieved complete response, 3% showed partial remission, and 2.7% had no response to therapy. Among the entire patient cohort, 11.6% tested positive for antinuclear antibodies, 3.5% for angiotensin-converting enzyme, and 12.3% for erythema nodosum. Notably, hypothyroidism was a prevalent condition among the patients, affecting 7.2% of the cohort. The incidence of common side effects was consistent across all groups. CONCLUSIONS The most effective treatment option for patients with recurrent or resistant IGM is a combination therapy involving steroids and disease-modifying antirheumatic drugs such as methotrexate.
Collapse
Affiliation(s)
- Fatemeh Shojaeian
- From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Shojaeian)
| | - Shahpar Haghighat
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Fereshteh Abbasvandi
- ATMP Department, Breast Cancer Research Centre, Motamed Cancer Institute, Tehran, Iran (Abbasvandi)
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Abbasvandi)
| | - Alireza Houshdar Tehrani
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Houshdar Tehrani)
| | - Niki Najar Najafi
- Cellular Molecular Biology, Faculty of life sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran (Najar Najafi)
| | - Ashkan Zandi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA (Zandi)
| | - Asiie Olfatbakhsh
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Maryam Sharifi
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran (Sharifi)
| | - Esmat Hashemi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), Iran University of Medical Sciences, Tehran, Iran (Nafissi)
| | - Safa Najafi
- Breast Cancer Research Center, Motamed Cancer Institute, ACECR, Tehran, Iran (Haghighat, Olfatbakhsh, Hashemi, Najafi)
| |
Collapse
|
3
|
Ong SS, Ho PJ, Liow JJK, Tan QT, Goh SSN, Li J, Hartman M. A meta-analysis of idiopathic granulomatous mastitis treatments for remission and recurrence prevention. Front Med (Lausanne) 2024; 11:1346790. [PMID: 38873201 PMCID: PMC11170159 DOI: 10.3389/fmed.2024.1346790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
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).
Collapse
Affiliation(s)
- Seeu Si Ong
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Jun Kit Liow
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Qing Ting Tan
- KK Breast Department, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Serene Si Ning Goh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| |
Collapse
|
4
|
Sarmadian R, Safi F, Sarmadian H, Shokrpour M, Almasi-Hashiani A. Treatment modalities for granulomatous mastitis, seeking the most appropriate treatment with the least recurrence rate: a systematic review and meta-analysis. Eur J Med Res 2024; 29:164. [PMID: 38475841 PMCID: PMC10929103 DOI: 10.1186/s40001-024-01761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Granulomatous mastitis (GM) is a rare, benign, inflammatory breast disease with an unknown etiology that predominantly affects women of reproductive age. The definitive treatment of GM is currently controversial; an appropriate therapeutic strategy has yet to be identified, and the disease's high recurrence rate remains. This study aims to determine the recurrence rate for each GM treatment strategy to identify the most appropriate treatment modality. METHODS The search for relevant articles was undertaken using three international databases, including Medline, Scopus, and Web of Science. Articles published in English until the end of 2021 evaluating the recurrence rate of GM were included. Using Stata 13.0, the pooled incidence and 95% confidence interval (CI) for the recurrence rate were determined. RESULTS Sixty-five eligible studies were included in our study. The recurrence rates of systemic steroid use, topical steroid use, antibiotic use, methotrexate use, observation, drainage, excision, antibiotic use and surgery, steroid use and surgery, antibiotic and steroid use, methotrexate and steroid use were 24% (95% CI: 21-27%), 11% (95% CI: 6-21%), 18% (95% CI: 14-22%), 13% (95% CI: 7-22%), 11% (95% CI: 7-17%), 65% (95% CI: 50-78%), 13% (95% CI: 10-16%), 23% (95% CI: 14-36%), 7% (95% CI: 5-11%), 11% (95% CI: 6-18%), and 4% (95% CI: 2-8%), respectively. Drainage had the highest recurrence rate, while combined methotrexate and steroid treatment had the lowest rate. CONCLUSION The optimal treatment strategy for GM depends on the disease's severity, consequences, and the patient's features. The study results indicate that combination therapy is preferable for minimizing the risk of relapse and reducing treatment complications.
Collapse
Affiliation(s)
- Roham Sarmadian
- Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Safi
- Department of Radiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Hossein Sarmadian
- Department of Infectious Diseases, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Maryam Shokrpour
- Department of Gynecology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Basij Square, Arak, Iran.
- Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran.
| |
Collapse
|
5
|
Zhang Q, Zhang W, Lv J, Zhang Z, Zhao Y. The Effect of Local Steroid Administration on Idiopathic Granulomatous Mastitis: A Systematic Review andMeta-Analysis. J Surg Res 2024; 295:511-521. [PMID: 38071781 DOI: 10.1016/j.jss.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory breast disease. Corticosteroids and surgery are the primary treatment options, and a growing number of publications have shown the effectiveness of local steroid administration (intralesional injection and topical corticosteroids). However, less is known about the specific details and effects of this treatment approach. The purpose of this meta-analysis was to summarize the details and evaluate the efficacy of local steroid administration for IGM. METHODS The PubMed, Embase, Cochrane Library, and SinoMed databases were systematically searched from inception to July 2023 to identify relevant randomized controlled trials. The quality of the included studies was assessed, and meta-analysis and subgroup analysis were conducted to obtain the pooled effect sizes of the outcomes of interest. RESULTS Eight trials comprising 613 patients were included. Local steroid administration included intralesional injection and topical steroid ointment, and control groups were mainly given systemic therapy (oral steroid) and surgical treatment. The meta-analysis showed that local steroid administration had a significant effect on the response rate (risk ratio [RR] = 1.35, 95% CI = [1.14-1.59], P = 0.0004). The incidence of side effects was also lower than that of systemic treatment (RR = 0.24, 95% CI = [0.13-0.43], P<0.0001). There was no difference in the recurrence rate (RR = 0.8, 95% CI = [1.42-1.51], P = 0.48). CONCLUSIONS Local steroid administration can increase the RR and decrease the incidence of side effects for IGM patients. There is no significant difference in the recurrence rate between the local steroid administration group and the control group. Further studies are needed to identify the effect in different stages and among pregnant women.
Collapse
Affiliation(s)
- Qiushi Zhang
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wentao Zhang
- Department of Breast Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Jing Lv
- Department of Breast Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhenxiang Zhang
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Yanli Zhao
- Department of Nursing and Health, Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
6
|
Dilaveri C, Degnim A, Lee C, DeSimone D, Moldoveanu D, Ghosh K. Idiopathic Granulomatous Mastitis. Breast J 2024; 2024:6693720. [PMID: 38304866 PMCID: PMC10834090 DOI: 10.1155/2024/6693720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/06/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare, benign inflammatory disorder of the breast that is often underrecognized. The exact etiology and pathophysiology are unknown, but milk stasis is felt to play a role. Classically, this condition is noninfectious, but many cases are noted to be associated with Corynebacterium species. Most patients affected are parous women with a mean age of 35, and many have breastfed within five years of diagnosis. Patients typically present with a painful mass and symptoms of inflammation, and these features can sometimes mimic breast cancer. Biopsy is needed to make a definitive diagnosis, and noncaseating granulomas are found on core biopsy. Many patients have a waxing and waning course over a period of six months to two years. Goal of treatment is to avoid surgery given poor wound healing, high risk of recurrence, and poor cosmetic outcomes. Medical treatment is preferred and includes observation, antibiotics, steroids, and immune modulators such as methotrexate. In more recent years, topical and intralesional steroids have become the treatment of choice, with similar outcomes to oral steroids.
Collapse
Affiliation(s)
- Christina Dilaveri
- Mayo Clinic, Department of Medicine, Division of General Internal Medicine, Rochester, USA
| | - Amy Degnim
- Mayo Clinic, Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Rochester, USA
| | - Christine Lee
- Mayo Clinic, Department of Radiology, Division of Breast Imaging and Intervention, Rochester, USA
| | - Daniel DeSimone
- Mayo Clinic, Department of Medicine, Division of Infectious Diseases, Rochester, USA
| | - Dan Moldoveanu
- Mayo Clinic, Department of Surgery, Division of Breast and Melanoma Surgical Oncology, Rochester, USA
| | - Karthik Ghosh
- Mayo Clinic, Department of Medicine, Division of General Internal Medicine, Rochester, USA
| |
Collapse
|
7
|
Moldoveanu D, Lee C, Hesley G. Framework and guide for intralesional steroid injections in idiopathic granulomatous mastitis. Eur J Radiol 2023; 168:111118. [PMID: 37804652 DOI: 10.1016/j.ejrad.2023.111118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Literature on how to perform intralesional steroid injections, a valuable therapy for idiopathic granulomatous mastitis (IGM), is limited. This technical note offers a detailed technical guide on intralesional steroid injections for IGM and provides a framework for long-term follow-up. METHODS Ultrasound characterization of IGM severity considering breadth, depth, and ancillary findings was used to guide steroid dosing and injection frequency. Clinical and sonographic breast diagrams were designed for accurate longitudinal tracking of IGM. A step-by-step guide for ultrasound-guided IGM aspirations and intralesional steroid injections was developed. RESULTS A detailed approach for ultrasound-guided IGM interventions with clinical and sonographic breast diagrams for longitudinal follow-up is now in practice. CONCLUSIONS The treatment approach described provides a framework for multidisciplinary treatment of IGM and offers insights that may contribute to the ongoing development and improvement of management strategies for this challenging disease.
Collapse
Affiliation(s)
- Dan Moldoveanu
- Department of Surgery, Breast and Melanoma Surgical Oncology, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
| | - Christine Lee
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States. https://twitter.com/MayoRadiology
| | - Gina Hesley
- Department of Radiology, Breast Imaging and Intervention, Mayo Clinic, 200 First St SW, Rochester MN, 55905, United States.
| |
Collapse
|
8
|
Cabioglu N, Uras C, Mutlu H, Sezgin D, Emiroglu S, Dulgeroglu O, Yilmaz R, Tukenmez M, Arikan AE, Kara H, Muslumanoglu M. Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy. Front Med (Lausanne) 2023; 10:1251851. [PMID: 37859855 PMCID: PMC10582626 DOI: 10.3389/fmed.2023.1251851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
Background Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Methods Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (<16 mg). Results Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; p = 0.080) to obtain an effective optimum therapeutic response. At a median of 12 months (range, 4-42), no difference was found in complete response rates between patients in the LSI group and the combined LSI group with OST (52 vs. 53.9%, p = 0.999). However, steroid-related systemic side effects were lower in the LSI alone group (p < 0.008). Conclusion Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.
Collapse
Affiliation(s)
- Neslihan Cabioglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Cihan Uras
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halime Mutlu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Derya Sezgin
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Selman Emiroglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Onur Dulgeroglu
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Mustafa Tukenmez
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Akif Enes Arikan
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halil Kara
- Department of Surgery, School of Medicine, Acibadem University, Istanbul, Türkiye
| | - Mahmut Muslumanoglu
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| |
Collapse
|
9
|
Kim D, Ahn J, Park E, Kim JY, Kim C. In vivo quantitative photoacoustic monitoring of corticosteroid-induced vasoconstriction. JOURNAL OF BIOMEDICAL OPTICS 2023; 28:082805. [PMID: 36844430 PMCID: PMC9951467 DOI: 10.1117/1.jbo.28.8.082805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Significance Corticosteroids-commonly prescribed medications for skin diseases-inhibit the secretion of vasodilators, such as prostaglandin, thereby exerting anti-inflammatory action by constricting capillaries in the dermis. The effectiveness of corticosteroids is determined by the degree of vasoconstriction followed by skin whitening, namely, the blanching effect. However, the current method of observing the blanching effect indirectly evaluates the effects of corticosteroids. Aim In this study, we employed optical-resolution photoacoustic (PA) microscopy (OR-PAM) to directly visualize the blood vessels and quantitatively evaluate vasoconstriction. Approach Using OR-PAM, the vascular density in mice skin was monitored for 60 min after performing each experimental procedure for four groups, and the vasoconstriction was quantified. Volumetric PA data were segmented into the papillary dermis, reticular dermis, and hypodermis based on the vascular characteristics obtained through OR-PAM. The vasoconstrictive effect of each skin layer was quantified according to the dermatological treatment method. Results In the case of corticosteroid topical application, vasoconstriction was observed in the papillary ( 56.4 ± 10.9 % ) and reticular ( 45.1 ± 4.71 % ) dermis. For corticosteroid subcutaneous injection, constriction was observed solely in the reticular ( 49.5 ± 9.35 % ) dermis. In contrast, no vasoconstrictions were observed with nonsteroidal topical application. Conclusions Our results indicate that OR-PAM can quantitatively monitor the vasoconstriction induced by corticosteroids, thereby validating OR-PAMs potential as a practical evaluation tool for predicting the effectiveness of corticosteroids in dermatology.
Collapse
Affiliation(s)
- Donggyu Kim
- Pohang University of Science and Technology, Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, Medical Science and Engineering, and Medical Device Innovation Center Group, Pohang, Republic of Korea
| | - Joongho Ahn
- Pohang University of Science and Technology, Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, Medical Science and Engineering, and Medical Device Innovation Center Group, Pohang, Republic of Korea
| | - Eunwoo Park
- Pohang University of Science and Technology, Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, Medical Science and Engineering, and Medical Device Innovation Center Group, Pohang, Republic of Korea
| | - Jin Young Kim
- Pohang University of Science and Technology, Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, Medical Science and Engineering, and Medical Device Innovation Center Group, Pohang, Republic of Korea
| | - Chulhong Kim
- Pohang University of Science and Technology, Departments of Electrical Engineering, Convergence IT Engineering, Mechanical Engineering, Medical Science and Engineering, and Medical Device Innovation Center Group, Pohang, Republic of Korea
| |
Collapse
|
10
|
Alhalaseh S, Smith J, Alziadin N, Gandrabur L. Challenging Management of a Breast Mass: Case Report and Literature Review. Cureus 2023; 15:e41855. [PMID: 37583723 PMCID: PMC10423851 DOI: 10.7759/cureus.41855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a rare benign pathology of inflammation in the breast that commonly affects parous women of reproductive age and men although it is extremely rare. It has an unusual predilection for Hispanic women born outside of the United States, most notably in Mexico. Recently, this entity has been described more. However, the approach to management is still very controversial, and the approaches vary widely, although surgical approaches, including excision or mastectomy, have been less favored recently as a primary approach. Here, we present a case of a young female of reproductive age who presented initially with a suspicious breast lump diagnosed initially in the breast clinic as IGM and was referred to the rheumatology clinic for management with medical therapy.
Collapse
Affiliation(s)
- Saleh Alhalaseh
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Jordan Smith
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | - Nmair Alziadin
- Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, USA
| | | |
Collapse
|
11
|
Ren Y, Zhang J, Zhang J, Guo R. Combining intralesional steroid injection with oral steroids in patients with idiopathic granulomatous mastitis. Medicine (Baltimore) 2023; 102:e34055. [PMID: 37327292 PMCID: PMC10270520 DOI: 10.1097/md.0000000000034055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease. Currently, there is no international standard for steroid use in IGM, particularly for intralesional steroid injections. This study aimed to determine whether patients with IGM who received oral steroids could benefit from intralesional steroid injection. We analyzed 62 patients with IGM whose main clinical presentation was mastitis masses and who received preoperative steroid therapy. Group A (n = 34) received combined steroid treatment: oral steroids (starting dose, 0.25 mg/kg/d; tapered off) and intralesional steroid injection (20 mg per session). Group B (n = 28) received oral steroids only (starting dose, 0.5 mg/kg/d; tapered off). Both groups underwent lumpectomy at the end of steroid treatment. We analyzed the preoperative treatment time, preoperative mass maximum diameter reduction rate, side effects, postoperative satisfaction, and rate of IGM recurrence. The mean age of the 62 participants was 33.6 ± 2.3 (range, 26-46) years, and all had unilateral disease. We found that oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone. The median maximum diameter reduction of the breast mass was 52.06% in group A and 30.00% in group B (P = .002). Moreover, the use of intralesional steroids reduced the duration of oral steroid use; the median durations of preoperative steroid therapy were 4 and 7 weeks in groups A and B, respectively (P < .001). Group A patients were more satisfied (P = .035) with the postoperative results, including postoperative appearance and function. No statistically significant between-group differences were noted regarding side effects and recurrence rates. Preoperative administration of oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone and may be an effective future treatment for IGM.
Collapse
Affiliation(s)
- Yun Ren
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Jiao Zhang
- Department of Diagnostic Radiology, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Jindan Zhang
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| | - Ruqi Guo
- Department of Breast Surgery, Changzhi People’s Hospital Affiliated to Shanxi Medical University, Changzhi, Shanxi Province, China
| |
Collapse
|
12
|
Yoshida N, Nakatsubo M, Yoshino R, Ito A, Ujiie N, Yuzawa S, Kitada M. Concurrent Granulomatous Mastitis and Ductal Carcinoma In Situ. Cureus 2023; 15:e38377. [PMID: 37265922 PMCID: PMC10230846 DOI: 10.7759/cureus.38377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 06/03/2023] Open
Abstract
Granulomatous mastitis (GM) is a benign inflammatory breast disease that often poses diagnostic challenges due to its similar clinical and radiographic features to breast cancer. We report the case of a 34-year-old female with concurrent GM and ductal carcinoma in situ (DCIS). Initially, breast cancer was suspected based on imaging; however, a needle biopsy confirmed GM. Corticosteroid treatment led to a reduction in tumor size, but subsequent imaging continued to suggest the presence of breast cancer. Surgical excision ultimately revealed the coexistence of GM and DCIS. It is essential to consider the possibility of concurrent breast cancer in cases of GM with discordant imaging and pathology findings.
Collapse
Affiliation(s)
- Nana Yoshida
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masaki Nakatsubo
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Ryusei Yoshino
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Akane Ito
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Nanami Ujiie
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Sayaka Yuzawa
- Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, JPN
| | - Masahiro Kitada
- Thoracic Surgery and Breast Surgery, Asahikawa Medical University Hospital, Asahikawa, JPN
| |
Collapse
|
13
|
Zhou S, Sheng C, Hu P, Ni X, Xu X, Song Q, Jiang X, Zhao H, Chen X. A Preliminary Study of Ultrasound-Guided Microwave Ablation for Nonpuerperal Mastitis Treatment. Breast Care (Basel) 2023; 18:1-11. [PMID: 36876169 PMCID: PMC9982351 DOI: 10.1159/000527128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction This study investigated the feasibility of ultrasound (US)-guided microwave ablation (MWA) as a treatment for nonpuerperal mastitis (NPM). Methods Fifty-three patients with NPM diagnosed by biopsy and treated with US-guided MWA at the Affiliated Hospital of Nantong University between September 2020 and February 2022 were classified according to whether they underwent MWA alone (n = 29) or MWA with incision and drainage (n = 24). Patients were followed up by interviews, physical and US examinations, and evaluation of breast skin at 1 week and 1, 2, and 3 months after treatment. Data from these patients were prospectively collected and retrospectively analyzed. Results The overall mean patient age was 34.42 ± 9.20 years. The groups differed significantly by age, involved quadrants, and the initial maximum diameter of lesions. In the MWA group, the cure rate was 34.48%, and the apparent efficiency rate was 65.52%. In the MWA with incision and drainage, the apparent efficiency rate was 91.66%, and the effective rate was 4.17%. The excellent rate for breast aesthetics in the MWA group was 79.31%, and the good rate was 20.69%. The excellent rate in the MWA with incision and drainage group was 45.83%, the good rate was 41.67%, and the qualified rate was 12.5%. The mean maximum diameter of lesions in the two groups decreased significantly. Conclusion For NPM with small lesions in a single quadrant, MWA therapy is a direct and effective method. For larger lesions involving two or more quadrants, the combined treatment of MWA with incision and drainage showed significant improvement in a short period. MWA treatment of NPM has importance for further research and clinical applications.
Collapse
Affiliation(s)
- Shengluan Zhou
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Chenyi Sheng
- Department of Thyroid and Breast Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Ping Hu
- Department of Traditional Chinese Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Xuejun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoping Xu
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Qian Song
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Xiaoxiao Jiang
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
| | - Hui Zhao
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xiaoyang Chen
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
14
|
Alper F, Abbasguliyev H, Özmen S, Yalçin A, Yılmaz Çankaya B, Nuran Akçay M. Clinical, Histopathological, Imaging, and Treatment Perspectives of Inflammatory Granulomatous Mastitis: Review of the Literature. Eurasian J Med 2022; 54:172-178. [PMID: 36655464 PMCID: PMC11163346 DOI: 10.5152/eurasianjmed.2022.22306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/29/2022] [Indexed: 01/19/2023] Open
Abstract
Inflammatory granulomatous mastitis is a benign inflammatory disease of the breast mostly presenting in puerperal women. The disease is characterized by recurrent bouts of mastitis with clinical picture of hyperemia, breast mass, and swelling of the breast with or without purulent discharge depending on the severity of the underlying inflammatory process. Although no true prevalence and incidence have been reported in the literature, there are several reported studies setting forth a predilection in specific ethnic groups and/ or geographical areas. Due to the intricate nature of the disease, quite often inflammatory granulomatous mastitis may be mistaken for malignant processes of the breast and even so, there are no pathognomonic imaging appearances to differentiate one from another. The histopathological analysis is a definite way of diagnosis. In this article, we review the imaging manifestations and clinical and histopathological findings along with current trends of available treatment options in the literature and briefly discussed our institutional perspective regarding grading of inflammatory granulomatous mastitis based on ultrasonographic appearances.
Collapse
Affiliation(s)
- Fatih Alper
- Department of Radiology, Atatürk University Faculty of Medicine, Atatürk University Research Hospital, Erzurum, Turkey
| | - Hasan Abbasguliyev
- Department of Radiology, Atatürk University Faculty of Medicine, Atatürk University Research Hospital, Erzurum, Turkey
| | - Sevilay Özmen
- Department of Pathology, Atatürk University Faculty of Medicine, Atatürk University Research Hospital, Erzurum, Turkey
| | - Ahmet Yalçin
- Department of Radiology, Atatürk University Faculty of Medicine, Atatürk University Research Hospital, Erzurum, Turkey
| | - Bahar Yılmaz Çankaya
- Department of Radiology, Atatürk University Faculty of Medicine, Atatürk University Research Hospital, Erzurum, Turkey
| | - Müfide Nuran Akçay
- Department of General Surgery, Atatürk University Faculty of Medicine, Atatürk University Research Hospital, Erzurum, Turkey
| |
Collapse
|
15
|
Tian C, Han X, Liu Z, Lv X, Ning P. Methotrexate and low‐dose corticosteroid: An effective alternate against corticosteroid‐resistant granulomatous lobular mastitis. J Obstet Gynaecol Res 2022; 48:2956-2963. [DOI: 10.1111/jog.15396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Chunxiang Tian
- Department of Breast Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Xiaorong Han
- Department of Breast Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Zeyu Liu
- Department of Breast Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Xinlin Lv
- Department of Breast Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| | - Ping Ning
- Department of Breast Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine University of Electronic Science and Technology of China Chengdu Sichuan China
| |
Collapse
|
16
|
Ling J, Xie X, Wang Y, Huang W, Luo J, Su J, Fan H, Wu S, Liu L. Differential expression profiles of miRNA in granulomatous lobular mastitis and identification of possible biomarkers. Exp Ther Med 2022; 24:500. [PMID: 35837043 PMCID: PMC9257833 DOI: 10.3892/etm.2022.11427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022] Open
Abstract
The etiology and pathogenesis of granulomatous lobular mastitis (GLM) remain largely elusive and the expression levels and regulatory roles of microRNAs (miRNAs or miRs) in GLM have remained mostly undetermined. In the present study, the miRNAs that were differentially expressed in breast biopsy samples from patients with GLM and normal tissue adjacent to fibroadenoma were analyzed, a comprehensive differential expression profile of miRNAs was provided and potential biomarkers were screened out. The expression profile of miRNAs was determined by high-throughput sequencing in the tissues of patients with GLM and healthy controls. Significantly differentially expressed miRNAs were screened by threshold setting and cluster analysis and their target genes were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Finally, circulating differentially expressed miRNAs between the GLM and control groups were further analyzed by reverse transcription-quantitative PCR (RT-qPCR). A total of 31,077 miRNAs were detected by high-throughput sequencing. By using the cutoff criteria of |log2 fold change|>2.5 and q<0.001, 13 miRNAs that were indicated to be GLM biomarkers were screened out. The expression levels of these 13 miRNAs in the GLM group were higher than those in the control group. GO and KEGG enrichment analyses suggested that the occurrence and development of GLM may be associated with autoimmune inflammation, metabolism and pathogenic organisms. miR-451a and miR-5571-3p were confirmed to be significantly increased in the serum of patients with GLM compared with their levels in the serum of healthy volunteers, which suggests that they may be used as biomarkers of GLM. To the best of our knowledge, the present study was the first report detailing genome-wide miRNA profiling of patients with GLM compared with controls. The possible targets and pathways of GLM were evaluated by bioinformatics analysis. The present study identified 13 differentially expressed miRNAs with important theoretical significance and potential application. Furthermore, miR-451a and miR-5571-3p were verified by RT-qPCR as possible biomarkers of GLM.
Collapse
Affiliation(s)
- Jie Ling
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Xianmin Xie
- Department of Hand Surgery, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Yue Wang
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Weifang Huang
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Jun Luo
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Jingqun Su
- Graduate School, Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Hongqiao Fan
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Shiting Wu
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| | - Lifang Liu
- Department of Galactophore, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan 41000, P.R. China
| |
Collapse
|
17
|
Toktas O, Toprak N, Elasan S, Calli I, Binici S. Treatment of Idiopathic Granulomatous Mastitis: Local Steroid Administration vs. Systemic (Oral) Steroid. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
18
|
Yuan QQ, Xiao SX, Farouk O, Du YT, Sheybani F, Tan QT, Akbulut S, Cetin K, Alikhassi A, Yaghan RJ, Durur-Subasi I, Altintoprak F, Eom TI, Alper F, Hasbahceci M, Martínez-Ramos D, Oztekin PS, Kwong A, Pluguez-Turull CW, Brownson KE, Chandanwale S, Habibi M, Lan LY, Zhou R, Zeng XT, Bai J, Bai JW, Chen QR, Chen X, Zha XM, Dai WJ, Dai ZJ, Feng QY, Gao QJ, Gao RF, Han BS, Hou JX, Hou W, Liao HY, Luo H, Liu ZR, Lu JH, Luo B, Ma XP, Qian J, Qin JY, Wei W, Wei G, Xu LY, Xue HC, Yang HW, Yang WG, Zhang CJ, Zhang F, Zhang GX, Zhang SK, Zhang SQ, Zhang YQ, Zhang YP, Zhang SC, Zhao DW, Zheng XM, Zheng LW, Xu GR, Zhou WB, Wu GS. Management of granulomatous lobular mastitis: an international multidisciplinary consensus (2021 edition). Mil Med Res 2022; 9:20. [PMID: 35473758 PMCID: PMC9040252 DOI: 10.1186/s40779-022-00380-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/07/2022] [Indexed: 02/07/2023] Open
Abstract
Granulomatous lobular mastitis (GLM) is a rare and chronic benign inflammatory disease of the breast. Difficulties exist in the management of GLM for many front-line surgeons and medical specialists who care for patients with inflammatory disorders of the breast. This consensus is summarized to establish evidence-based recommendations for the management of GLM. Literature was reviewed using PubMed from January 1, 1971 to July 31, 2020. Sixty-six international experienced multidisciplinary experts from 11 countries or regions were invited to review the evidence. Levels of evidence were determined using the American College of Physicians grading system, and recommendations were discussed until consensus. Experts discussed and concluded 30 recommendations on historical definitions, etiology and predisposing factors, diagnosis criteria, treatment, clinical stages, relapse and recurrence of GLM. GLM was recommended as a widely accepted definition. In addition, this consensus introduced a new clinical stages and management algorithm for GLM to provide individual treatment strategies. In conclusion, diagnosis of GLM depends on a combination of history, clinical manifestations, imaging examinations, laboratory examinations and pathology. The approach to treatment of GLM should be applied according to the different clinical stage of GLM. This evidence-based consensus would be valuable to assist front-line surgeons and medical specialists in the optimal management of GLM.
Collapse
Affiliation(s)
- Qian-Qian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Shu-Xuan Xiao
- Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL 60637 USA
| | - Omar Farouk
- Department of Surgical Oncology and Breast Surgery, Oncology Center, Faculty of Medicine, Mansoura University, Mansoura, 35516 Egypt
| | - Yu-Tang Du
- Department of Breast Surgery, Beijing University of Chinese Medicine, Beijing, 100700 China
| | - Fereshte Sheybani
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, 9177899191 Iran
| | - Qing Ting Tan
- Breast Department, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore
| | - Sami Akbulut
- Department of Surgery, Department of Public Health, Department of Biostatistics, Bioinformatics and Medical Informatics, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - Kenan Cetin
- Department of General Surgery, Faculty of Medicine, Çanakkale Onsekiz Mart University, 17020 Çanakkale, Turkey
| | - Afsaneh Alikhassi
- Department of Radiology, Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, 1419733141 Iran
| | - Rami Jalal Yaghan
- Department of Surgery, College of Medicine and Medical Sciences, Arabian Gulf University-Bahrain, Manama, 26671 Bahrain
| | - Irmak Durur-Subasi
- Department of Radiology, International Faculty of Medicine, Istanbul Medipol University, 34810 Istanbul, Turkey
| | - Fatih Altintoprak
- Department of General Surgery, Faculty of Medicine, Sakarya University, 54050 Sakarya, Turkey
| | - Tae Ik Eom
- Department of Surgery, HiU Clinic, 170, Gwongwang-ro, Paldal-gu, Suwon, 16488 Korea
| | - Fatih Alper
- Department of Radiology, Faculty of Medicine, Ataturk University, 25240 Erzurum, Turkey
| | - Mustafa Hasbahceci
- Academic Support and Education Center, Hırkai Serif District, Kececi Cesmesi Str, Doktorlar Building, B/7, 34091 Istanbul, Turkey
| | - David Martínez-Ramos
- Department of General and Digestive Surgery, Hospital General Castellon, Avda Benicassim S/N, 12812004 Castellón, Spain
| | - Pelin Seher Oztekin
- Radiology Department, Ankara Training and Research Hospital, 305018 Ankara, Turkey
| | - Ava Kwong
- Department of Surgery, The University of Hong Kong, China; The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518053 China
| | - Cedric W. Pluguez-Turull
- University of Miami Health System and Miller School of Medicine, 1475 NW 12th Avenue, Miami, FL 33136 USA
| | - Kirstyn E. Brownson
- Department of Surgery, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT 84112 USA
| | - Shirish Chandanwale
- Department of Pathology, Dr D Y Patil Medical College Hospital and Research Centre, Pimpri, Pune, 603203 India
| | - Mehran Habibi
- Department of Surgery, Johns Hopkins Breast Center at Bayview Campus, 4940 Eastern Avenue, Rm. A-562, Baltimore, MD 21224 USA
| | - Liu-Yi Lan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Rui Zhou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Jiao Bai
- Department of Diagnostic Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Jun-Wen Bai
- Department of Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010110 China
| | - Qiong-Rong Chen
- Center for Pathology and Molecular Diagnostics, Wuhan University, Wuhan, 430071 China
| | - Xing Chen
- Department of General Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Xiao-Ming Zha
- The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029 China
| | - Wen-Jie Dai
- Key Laboratory of Hepatosplenic Surgery and the First Department of General Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, 150007 China
| | - Zhi-Jun Dai
- Department of Breast Surgery, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, 310003 China
| | - Qin-Yu Feng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Qing-Jun Gao
- Department of General Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004 China
| | - Run-Fang Gao
- Department of General Surgery, Shanxi Provincial People’s Hospital, Taiyuan, 030012 China
| | - Bao-San Han
- Department of Breast Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092 China
| | - Jin-Xuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Wei Hou
- Department of Cardiothoracic Surgery, Zaoyang People’s Hospital, Zaoyang, 441299 Hubei China
| | - Hai-Ying Liao
- Department of Thyroid and Breast Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, 050004 China
| | - Hong Luo
- Department of General Surgery, Guangshan County People’s Hospital, Guangshan County, Xinxiang, 465499 Henan China
| | - Zheng-Ren Liu
- Department of Breast Surgery, First Affiliated Hospital of Nanchang University, Nanchang, 330006 China
| | - Jing-Hua Lu
- Chinese Academy of Sciences, Beijing, 100045 China
| | - Bin Luo
- Department of General Surgery, School of Clinical Medicine, Tsinghua University, Beijing Tsinghua Changgung Hospital, Beijing, 102218 China
| | - Xiao-Peng Ma
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital, Hefei, 230001 China
| | - Jun Qian
- Department of Thyroid Surgery, First Affiliated Hospital of Kunming Medical University, Kunming, 650032 China
| | - Jian-Yong Qin
- Department of Oncology, Liwan Central Hospital of Guangzhou, Guangzhou, 510150 China
| | - Wei Wei
- Department of Breast Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036 Guangdong China
| | - Gang Wei
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Li-Ying Xu
- Department of Computed Tomography, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Hui-Chao Xue
- Department of General Surgery, Xinxiang Medical University First Affiliated Hospital, Xinxiang, 453100 Henan China
| | - Hua-Wei Yang
- Department of Breast Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021 China
| | - Wei-Ge Yang
- Department of General Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032 China
| | - Chao-Jie Zhang
- Department of Breast and Thyroid Surgery, Hunan Provincial People’s Hospital/The First Affiliated Hospital of Hunan Normal University, Changsha, 410005 China
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013 China
| | - Guan-Xin Zhang
- Department of General Surgery, Qinghai Province People’s Hospital, Xining, 810007 China
| | - Shao-Kun Zhang
- Department of Thyroid and Breast Surgery, Qingdao Women and Children’s Hospital, Qingdao, 266000 Shandong China
| | - Shu-Qun Zhang
- Department of Oncology, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, 710004 China
| | - Ye-Qiang Zhang
- Department of Cardiothoracic Surgery, Zaoyang First People’s Hospital, Zaoyang, 441299 Hubei China
| | - Yue-Peng Zhang
- Department of Diagnostic Ultrasound, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Sheng-Chu Zhang
- Department of Thyroid and Breast Surgery, Yichang Central People’s Hospital, Yichang, 443003 Hubei China
| | - Dai-Wei Zhao
- Department of Thyroid Surgery, The Second Affiliated Hospital, Guizhou Medical University, Kaili, 556000 Guizhou China
| | - Xiang-Min Zheng
- Department of General Surgery, Shanghai Changzheng Hospital, Shanghai, 200003 China
| | - Le-Wei Zheng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Gao-Ran Xu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| | - Wen-Bo Zhou
- Department of Surgery, Dongfeng General Hospital Affiliated with Hubei Medical College, Shiyan, 442001 Hubei China
| | - Gao-Song Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071 China
| |
Collapse
|
19
|
Alsaleh N. Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: Review of literature. Ann Med Surg (Lond) 2021; 70:102792. [PMID: 34691410 PMCID: PMC8519765 DOI: 10.1016/j.amsu.2021.102792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
Idiopathic granulomatous mastitis (IGM) is a benign persistent inflammatory breast entity characterized histologically by lobulo centric granulomas. Diagnosis may be difficult and involves a strong index of suspicion. There are plentiful studies are published which render the disease more frequently than expected. The strategy for imaging IGM depends on patient age, clinical manifestations, and risk factors. Patients have an excellent prognosis when they are appropriately treated. The management remains contentious, good judgment is required to ensure optimum treatment form and timing.
Collapse
Affiliation(s)
- Nuha Alsaleh
- Division of General Surgery, Department of Surgery, College of Medicine and King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
20
|
Toktas O, Toprak N. Treatment Results of Intralesional Steroid Injection and Topical Steroid Administration in Pregnant Women with Idiopathic Granulomatous Mastitis. Eur J Breast Health 2021; 17:283-287. [PMID: 34263157 DOI: 10.4274/ejbh.galenos.2021.2021-2-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/20/2021] [Indexed: 12/01/2022]
Abstract
Objective Idiopathic granulomatous mastitis (IGM) is an inflammatory and chronic benign breast disease that has proven difficult to diagnose and treat. Since most treatment modalities cannot be used in pregnant patients, the choice of treatment is more difficult and the need for surgery is more pressing. In this first and innovative study, we assess the results of local corticosteroid therapy of IGM in pregnant women. Materials and Methods Pregnant women with IGM were evaluated between June 2017 and May 2019. The six pregnant women were treated using intralesional steroid injections and topical steroid administration. The treatment response was evaluated, both clinically and radiologically, at the end of 2 weeks and once more at the end of 1 month. Results The median patient age was 26 years. The mean duration of complaints was 4.3 months. The median number of children was 2, and the mean breastfeeding time was 41 months. The predominant complaints at onset were a breast mass or local pain and inflammation in four (66.7%) patients and a breast mass with pain and without signs of local skin inflammation in two (33.3%) patients. Diagnosis was made using a tru-cut biopsy in two patients, and with an incisional biopsy in four patients who had abscess drainage and fistulation to the skin. Five (83.3%) patients achieved a complete response, and one (16.7%) patient responded only partially after the first course of treatment. A second course of treatment was given to the patient with partial response. All patients achieved complete response at the end of the second course of treatment. The mean follow-up time was 19.5 months. During the follow-up period, one patient experienced a recurrence at 4 months after giving birth, and she then received a third course of treatment. Topical and systemic side effects of the corticosteroids were not observed in any patient. Conclusion While the state of pregnancy generally precludes the use of most drugs, the use of local corticosteroid in the treatment of IGM is effective in terms of treatment response, treatment duration, need for surgery, and reduced recurrence and side effects.
Collapse
Affiliation(s)
- Osman Toktas
- Department of Surgery, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| | - Nurşen Toprak
- Department of Radiology, Van Yüzüncü Yıl University Faculty of Medicine, Van, Turkey
| |
Collapse
|
21
|
Ertürk TF, Çakır Ö, Yaprak Bayrak B, Güneş A, Aydemir S, Utkan NZ. Local Steroid Treatment: An Effective Procedure for Idiopathic Granulomatous Mastitis, Including Complicated Cases. J INVEST SURG 2021; 35:745-751. [PMID: 34154493 DOI: 10.1080/08941939.2021.1933272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the effectiveness of treatment with topical and intralesional steroids for idiopathic granulomatous mastitis (IGM) and to compare with surgical methods. METHODS Data were retrospectively collected from records. Intralesional steroid injection and topical steroid administration, hereafter referred to as local steroid treatment (LST) were applied in Group 1. Surgery (local excision, wide excision, and mastectomy) was performed in Group 2. In Group 1, changes in lesion sizes were recorded and factors complicating treatment were identified. The Numeric Pain Rating Scale was used to determine subjective pain. LST and surgery were compared with regard to: pain before and after the treatment; complication rate; recurrence rate; and treatment cost. RESULTS There were 38 and 48 patients in Group 1 and Group 2, respectively. In the LST group, 72 lesions were present and 70 of 72 (97%) responded completely to treatment. Pretreatment median maximum diameter was 23.50 (15.25-35.25) mm, which regressed to 16 (12-25) mm after the first session. While the pretreatment pain scores of Group 1 and Group 2 were similar (p = 0.756), there was a significant difference in the post-treatment pain scores (p < 0.001). No recurrence occurred in any patients in Group 1, while recurrence developed in 15 (31.2%) patients in Group 2 (p < 0.001). CONCLUSION LST is a treatment for IGM that is cheap, with high efficiency, negligible recurrence, and has good esthetic outcome. Our results suggest that LST should be the first-line treatment option for all IGM patients, including complicated cases.
Collapse
Affiliation(s)
- Taha Furkan Ertürk
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Türkiye
| | - Özgür Çakır
- Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Türkiye
| | - Büşra Yaprak Bayrak
- Department of Pathology, Kocaeli University School of Medicine, Kocaeli, Türkiye
| | - Abdullah Güneş
- Department of General Surgery, Health Sciences University Derince Training and Research Hospital, Kocaeli, Türkiye
| | - Selahattin Aydemir
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Türkiye
| | - Nihat Zafer Utkan
- Department of General Surgery, Kocaeli University School of Medicine, Kocaeli, Türkiye
| |
Collapse
|
22
|
Koksal H. Response to Re: The Clinical Utility of Autoantibodies in Patients with Idiopathic Granulomatous Mastitis. J INVEST SURG 2021; 35:680-681. [PMID: 33655820 DOI: 10.1080/08941939.2021.1893415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hande Koksal
- Department of General Surgery, Saglik Bilimleri University, Hamidiye Faculty of Medicine, Ministry of Health Konya City Hospital, Konya, Turkey
| |
Collapse
|
23
|
Ates D, Doner HC, Kurban S, Koksal H. The Effect of Soluble TREM-1 in Idiopathic Granulomatous Mastitis. Immunol Invest 2021; 51:839-850. [PMID: 33522329 DOI: 10.1080/08820139.2021.1879846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and objectives: The aim of this study is to investigate the effect of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in idiopathic granulomatous mastitis (IGM).Methods: This case-control study was conducted in Saglik Bilimleri and Necmettin Erbakan Universities. Sixty patients with IGM diagnosis (Group P) and 25 healthy females as control group (Group C) were included. Group P was divided into two subgroups according to the activity of disease: patients with active lesion (Group PA), and patients without any symptoms, in remission (Group PR). The ELISA method was used to measure sTREM-1 level.Results: Group P's sTREM-1 were higher than Group C (p < .0001). The difference between sTREM-1 levels of Groups PA, PR and C was significant statistically (p < .0001). Group PA's sTREM-1 levels were higher than Group C (p < .0001). Also, sTREM-1 levels of Group PR were higher than Group C (p = .006). When sTREM-1 levels of patients receiving steroid therapy and did not in Group PR were analyzed, the sTREM-1 levels of the patients not receiving steroid treatment were found to be statistically higher than Group C (p = .002). Although the sTREM-1 levels of the patients who did not receive steroid therapy were higher than those who received steroid therapy, the difference was not statistically significant (p > .05).Conclusion: We concluded that the detected high sTREM-1 levels contributed to inflammation in IGM. In particular, blockade of TREM may be a promising treatment option in resistant or multiple recurrent patients.
Collapse
Affiliation(s)
- Dervis Ates
- Department of General Surgery, Breast Unit, Saglik Bilimleri University, Hamidiye Faculty of Medicine, Ministry of Health Konya City Hospital, Konya, Turkey
| | - Hulusi Cem Doner
- Department of Biochemistry, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Sevil Kurban
- Department of Biochemistry, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - Hande Koksal
- Department of General Surgery, Breast Unit, Saglik Bilimleri University, Hamidiye Faculty of Medicine, Ministry of Health Konya City Hospital, Konya, Turkey
| |
Collapse
|
24
|
Koksal H. What are the new findings with regard to the mysterious disease idiopathic granulomatous mastitis? Surg Today 2021; 51:1158-1168. [PMID: 33511459 DOI: 10.1007/s00595-020-02204-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/14/2020] [Indexed: 01/30/2023]
Abstract
PURPOSE To review the demographic and clinical features and the success rates of treatment approaches for idiopathic granulomatous mastitis (IGM). METHODS A total of 134 patients diagnosed with IGM pathologically and treated by a single breast surgeon were retrospectively analyzed. RESULTS The time between the occurrence of symptoms and the last delivery was < 24 months in 25 (23.1%), 24-48 months in 51 (38.1%), and > 48 months in 52 (38.8%). The difference was statistically significant (p = 0.002). Although there was no significant difference, seasonal fluctuations were noticed, with the incidence being slightly higher during late spring and summer. Bilateral disease was present in 10 (7.5%) patients. Seven patients (5.2%) had erythema nodosum. The treatment approaches were conservative in 42, surgical procedures in 48, steroid treatment in 18, and surgical procedure + steroid treatment in 24. The median recovery time with conservative approaches was lower than that with surgical procedure + steroid treatment (p < 0.0001). Recurrence developed in 10 patients (7.7%). CONCLUSION Clinical differences were detected among the patients with IGM, and classification of patients by severity is needed to plan the optimal treatment approach. Seasonal fluctuations suggest the possibility of an immunological disease rather than a surgical disease.
Collapse
Affiliation(s)
- Hande Koksal
- Department of General Surgery, Ministry of Health Konya City Hospital, Hamidiye Faculty of Medicine, Saglik Bilimleri University, 42040, Konya, Turkey.
| |
Collapse
|
25
|
Koksal H. The Clinical Utility of Autoantibodies in Patients with Idiopathic Granulomatous Mastitis. J INVEST SURG 2020; 35:325-329. [PMID: 33327830 DOI: 10.1080/08941939.2020.1861666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although the etiopathogenesis of idiopathic granulomatous mastitis (IGM) is still controversial, recently autoimmunity and immune dysregulation have been emphasized. The aim of this study is to investigate the clinical utility of autoantibodies in IGM. MATERIAL AND METHODS Rheumatoid factor (RF), antinuclear antibody (ANA), anti-double stranded DNA antibody (anti-ds-DNA), anti-cyclic citrullinated peptides antibody (anti-CCP) and perinuclear anti-neutrophil cytoplasmic antibody (pANCA) levels were investigated in pathologically diagnosed IGM patients (Group IGM) and healthy women (Group C). IGM patients were divided into two groups as those with active symptoms and signs (Group IGMA) and those without clinical and radiological findings (Group IGMR). RESULTS While, in Group IGM, the positivity of RF, ANA, anti-ds-DNA, pANCA and anti-CCP was 13.1%, 3.3%, 1.6%, 0%, and 3.3%, respectively, in Group C, they were 13.3%, 0%, 0%, 0%, and 0%, respectively. The differences were not statistically significant (p > .05). In Groups IGMA, IGMR and C, RF positivity was 10%, 16.1%, and 13.3%, respectively. The ANA positivity of Groups IGMA, IGMR and C was 0%, 6.5%, and 0%, respectively. Groups IGMA, IGMR and C's anti-ds-DNA positivity were 0%, 3.2%, and 0%, respectively. In all groups, pANCA was negative. The anti-CCP positivity of Groups IGMA, IGMR and C was 6.7%, 0%, and 0%, respectively. CONCLUSION Our findings did not support the clinical utility of autoantibodies including RF, ANA, anti-ds-DNA, pANCA and anti-CCP in IGM.
Collapse
Affiliation(s)
- Hande Koksal
- Department of General Surgery, Saglik Bilimleri University, Hamidiye Faculty of Medicine, Ministry of Health Konya City Hospital, Konya, Turkey
| |
Collapse
|