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Non-surgical Management in Idiopathic Granulomatous Mastitis

Mohammad Esmaeil Akbari, Saran Lotfolahzadeh, Nahid Nafissi, Atieh Akbari and Maryam Khayamzadeh

Introduction: Idiopathic Granulomatous Mastitis; Despite its low incidence, is in high interest due to masquerading as carcinoma of the breast. In confirmed IGM case series, it`s been reported that more than 50% of patients were initially misdiagnosed as affecting by carcinoma of the Breast. Herein we are introducing a non-surgical management of IGM with frequently aspiration of the masses accompanied by using bacteriostatics and close regular surveillance.
Material and Method: This was a before and after clinical trial looking at the effects of repeated aspirations coupled with antibiotic treatment on the natural course of IGM. Overall 55 patients met the inclusion criteria. These patients underwent clinical and imaging study as well as Core Needle Biopsy (CNB) of the lesion with a 14-16 Gauge needle. Patients` presenting sign and symptoms were categorized into six variable ones, including inflammation, Erythma, mass, pain and sinus formation. Confirmed cases of IGM were treated with antibiotic therapy (Ciprofloxacin 500 mg, or Trimethoprin-Sulfamethoxazol 400+80 mg every 12 hours) until either the relief of symptoms or a maximum of 3 weeks. One or two Weeks follow up visits were conducted in the first three months, monthly visits in the first six months, and then no matter when the last visit was done, it was recorded.
Results: 44 patients (80% of cases), elucidated signs of inflammation, whereas solely 18 patients (32% of cases) were presented with inflamed breasts at final visit. (P value=0.03) 45 patients (81% of cases) presenting symptom was erythema, ultimately there were 14 cases (25%) in whom erythema persists. (p value=0.03) Mass presence was the dominant sign being discovered in 45 (72%) of enrolled cases at the time of first visit. The reported results has experienced a decline curve, finally 10 cases (18%) has remained symptomatic with a mass. (P value=0.02) Furthermore pain was elucidated in more than half of those who entered the study, 25 cases (56%). Sinus formation has complicated 14.5% (8 cases) of the patients, interestingly followed by a minimal rise at second visit during 1-3 weeks, the number of affected patients was consistently reported as 7 patients (12%) during the further visits.
Discussion and Conclusion: Because of the nature of the disease which is an inflammatory reaction, any form of surgical intervention will be an unsuitable procedure and may become a disaster for both patient and the physician. As a result, the procedure of recurrent drainage may resolve the symptoms of pain, erythema and possibly the sinus formation, ultimately the mass will be resolved; therefore the recurrent drainage is highly recommended.