A. J. Green1,2, T. Rana2, P. Twomey1,2, R. Godfrey1,2 1University Of California – San Francisco,East Bay Surgery,San Francisco, CA, USA 2Highland General Hospital,Surgery Department,Oakland, CA, USA
Introduction:
Granulomatous mastitis is a chronic inflammatory disease of the breast that is considered idiopathic and has a debated etiology. The clinical presentation of the disease often mimics breast cancer. There is no consensus on the best treatment and methods range from observation and antibiotics to systemic steroids and mastectomy.
Our objective was to determine if conservative management of granulomatous mastitis without steroids and definitive surgery provides effective management for this disease.
Methods:
A retrospective review of institutional records of Highland Hospital in Oakland, California of all patients with a histopathologic diagnosis of granulomatous mastitis from June 2005 though July 2015. Demographic, clinical and outcomes data were analyzed using summary statistics.
We defined definitive surgery as mastectomy, lumpectomy or excisional biopsy.
Results:
A total of 46 women with granulomatous mastitis were identified. The mean age was 33.9 (range 24 – 55 years). 62.2% of women received conservative management with 85% resolution. This includes 22.2% who received only core needle biopsy or fine needle aspiration (88.9% resolution) and 40% who received incision and drainage (86.7% resolution). 35.6% received excisional biopsy. 68.8% of patients undergoing excisional biopsy also had a BIRADS 4 or higher reading on ultrasound or mammogram. 91.7% of patients with excisional biopsy had resolution of symptoms. A single patient (2.2%) received steroids after failed conservative management and continued to be symptomatic. Conservative management was successful in 87.5% of cases. The mean duration of follow up was 11.8 months (range 1 week to 45 months).
Significantly, 91.3% of patients with granulomatous mastitis were Hispanic. Approximately 30% of our hospital patients are Hispanic.
Conclusion:
Conservative management with interventions limited to aspiration, incision and drainage and antibiotics is frequently effective in the management of granulomatous mastitis. However, the radiologic and clinical presentation can mimic breast cancer, and excisional biopsy is often required to rule out a diagnosis of malignancy. Patients treated without steroids had recovery rates comparable to treatment with steroids reported in the literature.