Clinicopathological characteristics and classified treatment of 218 patients with granulomatous mastitis

Abstract

Objective To explore the outcome of classified treatment in granulomatous mastitis patients. Methods The clinical data of 218 patients with granulomatous mastitis who were admitted to the Guangdong Women and Children's Hospital from January 2013 to December 2015 and had complete medical records were retrospectively analyzed, including basic clinical data, imaging findings, pathological characteristics, treatment methods and outcomes. The positive rate of corynebacteria and the incidence of hyperprolactinemia among three types of granulomatous mastitis (refractory, mass and abscess type) were adalyzed by χ2 test. Results The patients were non-lactational women at the age of (33.5±3.9) years. They had the onset of mastitis (3.6±1.6) years after ablactation, and 63.8%(139/218) of them had the history of breast-feeding disorders at different degrees. Totally 97.2%(212/218)of patients had breast mass. According to the first clinical manifestation, 218 cases were divided into three types, including 41 cases of mass type, 126 cases of abscess type and 51 cases of refractory type. The specimens of pus were obtained in 96 patients, including 61 cases of abscess type and 35 cases of refractory type. The positive rate of corynebacteria showed no significant difference between abscess type and refractory type [9.8%(6/61) vs 8.6(3/35), χ2=0.025, P=0.900]. The incidence of hyperprolactinemia among the three types was significantly different (χ2 = 22.280, P<0.001). The incidence of hyperprolactinemia in refractory type was significantly higher than that in lump type or abscess type [58.8%(30/51) vs 17.1%(7/41), 58.8%(30/51) vs 27.0%(34/126), χ2=16.487, 15.944, both P<0.017]. Steroid therapy was applied in 95.9% (209/218) of granulomatous mastitis patients. The antibiotic and anti-mycobacterial drugs were used in 21.1%(46/218) of the cases, which achieved some beneficial effect. The patients were followed up for median 15.8 months (range: 6.0-32.0 months), with a recurrence rate of 11.0% (24/218). The granulomatous mastitis of lump type had the lowest recurrence rate of 2.4% (1/41). Conclusions The etiology of granulomatous mastitis is unclear. Steroid therapy is mainly used for granulomatous mastitis and the antibiotic and anti-mycobacterial drugs are effective in some cases. The patients with lump type have the highest efficacy after treatment. Key words: Granuloma; Mastitis; Diagnosis; Surgical procedures, operative; Steroid