Is it possible to avoid the late diagnosis of idiopathic granulomatous mastitis?

Abstract

Introduction: Idiopathic granulomatous mastitis (MGI) is a rare chronic inflammatory disease of unknown etiology. Its diagnosis is one of exclusion, it requires a histological sample that confirms the presence of granulomas, and specific cultures that rule out other causes of granulomatous disease. The initial mismanagement of these patients due to the lack of sampling for histological study and cultures, leads to a delay in diagnosis. There is no established treatment for this pathology, with surgical treatment and medical treatment with corticosteroids being the most used, either individually or in combination. Objectives: To determine the incidence of MGI in those patients who consulted for inflammatory lesions of the breast and its incidence in those who finally underwent surgical treatment. Identify clinical characteristics that allow an initial diagnostic suspicion, and establish guidelines for surgical management that allow an early diagnosis. Material and Methods: A retrospective, cross-sectional and descriptive work was carried out. The medical records of all patients undergoing surgical treatment of the breast for inflammatory lesions in the period from February 2018 to February 2020 were evaluated at the Gynecology and Obstetrics Service of the Sanatorio Güemes of Buenos Aires. Its clinicopathological characteristics, type of surgery performed and whether it required subsequent corticosteroid treatment were analyzed. Results: In the period of time analyzed, 410 patients consulted for an inflammatory breast process, where only 10 of them (2.44%) had a diagnosis of MGI. If we consider those with surgical indication, the incidence of MGI amounts to 32.25% (31 patients). Ten patients had at least 2 previous consultations with a presumptive diagnosis of acute mastitis treated with different antibiotic regimens prior to the definitive diagnosis. Half of the patients required 2 surgical interventions prior to diagnosis. The average time interval elapsed between the first consultation and the definitive diagnosis was 4 months. Conclusion: Patients with inflammatory breast disease with surgical indication, the differential diagnosis between abscessed acute mastitis and MGI should be considered, especially in the subpopulation of patients between 30-40 years of age, multiparous, and with multiple previous consultations for breast inflammatory processes refractory to antibiotic treatments. The surgical approach must include biopsy and specific cultures.