Lymphadenopathy Risk in Idiopathic Granulomatous Mastitis, Association with Clinical Signs and Ultrasound Parameters: A Cross-Sectional Study
Abstract
Background: Idiopathic Granulomatous mastitis (IGM) is a rare inflammatory breast disease posing diagnostic challenges. To investigate the risk of lymphadenopathy (LAP) associated with clinical signs, demographic factors and ultrasound parameters in IGM patients.
Methods: This cross-sectional study was conducted at the Breast Clinic of a university-affiliated hospital. Data were collected from medical records of patients diagnosed with IGM between January and February 2023. Patients with complete medical records and diagnosed with IGM were included. The outcome of interest was LAP. Logistic regression (LR) analysis was performed to investigate the association between LAP and clinical signs, demographic factors, and ultrasound parameters.
Results: Finally, 140 patients with GM were included in this study. The prevalence of LAP among IGM patients was 20%. The logistic regression analysis revealed a non-significant association between LAP and IGM (Adjusted OR: 0.823, 95% CI: 0.154–4.39, P = 0.819). Similarly, clinical history variables, including age, breastfeeding, breast invasion, and marital status, did not show significant associations with IGM. However, logistic regression analysis identified significant associations between lymphadenopathy and LAP (Adjusted OR: 58.73, 95% CI: 17.23–200.15, P < 0.001) as well as axillary lymphadenopathy (Adjusted OR: 15.9, 95% CI: 10.53–28.1, P < 0.001).
Conclusion: These findings highlight the complex interplay between clinical and imaging features in IGM, with axillary LAP and nodular LAP emerging as particularly interrelated characteristics.
References
Centers for Disease C, Prevention. Idiopathic granulomatous mastitis in Hispanic women - Indiana, 2006-2008. MMWR Morb Mortal Wkly Rep. 2009;58(47):1317-21. doi: NA.
Barreto DS, Sedgwick EL, Nagi CS, Benveniste AP. Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings. Breast Cancer Res Treat. 2018;171(3):527-34. doi: 10.1007/s10549-018-4870-3.
Guirguis MS, Adrada B, Santiago L, Candelaria R, Arribas E. Mimickers of breast malignancy: imaging findings, pathologic concordance and clinical management. Insights Imaging. 2021;12(1):53. doi: 10.1186/s13244-021-00991-x.
Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases. 2014;2(12):852-8. doi: 10.12998/wjcc.v2.i12.852.
Krawczyk N, Kuhn T, Ditsch N, Hartmann S, Gentilini OD, Lebeau A, et al. Idiopathic Granulomatous Mastitis as a Benign Condition Mimicking Inflammatory Breast Cancer: Current Status, Knowledge Gaps and Rationale for the GRAMAREG Study (EUBREAST-15). Cancers (Basel). 2024;16(19). doi: 10.3390/cancers16193387.
Vanovcanova L, Lehotska V, Machalekova K, Waczulikova I, Minarikova E, Rauova K, et al. Idiopathic Granulomatous Mastitis - a new approach in diagnostics and treatment. Neoplasma. 2019;66(4):661-8. doi: 10.4149/neo_2019_190201N100.
Shojaee L, Rahmani N, Moradi S, Motamedi A, Godazandeh G. Idiopathic granulomatous mastitis: challenges of treatment in iranian women. BMC Surg. 2021;21(1):206. doi: 10.1186/s12893-021-01210-6.
Tan QW, Zhang YN, Jia YP, Gou J, Lv Q, Yang XQ. Methylprednisolone for idiopathic granulomatous mastitis: a prospective observational cohort study. Gland Surg. 2022;11(9):1538-45. doi: 10.21037/gs-22-484.
Oztekin PS, Durhan G, Nercis Kosar P, Erel S, Hucumenoglu S. Imaging Findings in Patients with Granulomatous Mastitis. Iran J Radiol. 2016;13(3):e33900. doi: 10.5812/iranjradiol.33900.
Ozturk M, Mavili E, Kahriman G, Akcan AC, Ozturk F. Granulomatous mastitis: radiological findings. Acta Radiol. 2007;48(2):150-5. doi: 10.1080/02841850601128975.
Seo HR, Na KY, Yim HE, Kim TH, Kang DK, Oh KK, et al. Differential diagnosis in idiopathic granulomatous mastitis and tuberculous mastitis. J Breast Cancer. 2012;15(1):111-8. doi: 10.4048/jbc.2012.15.1.111.
Wolfrum A, Kummel S, Theuerkauf I, Pelz E, Reinisch M. Granulomatous Mastitis: A Therapeutic and Diagnostic Challenge. Breast Care (Basel). 2018;13(6):413-8. doi: 10.1159/000495146.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD.
Murray ME, Given-Wilson RM. The clinical importance of axillary lymphadenopathy detected on screening mammography. Clin Radiol. 1997;52(6):458-61. doi: 10.1016/s0009-9260(97)80008-6.
Mohseni S, Shojaiefard A, Khorgami Z, Alinejad S, Ghorbani A, Ghafouri A. Peripheral lymphadenopathy: approach and diagnostic tools. Iran J Med Sci. 2014;39(2 Suppl):158-70. doi: NA.
Koseoglu HI, Dasiran MF, Koseoglu RD, Celikyay ZRY, Kalelioglu MB. Is it tuberculosis mastitis or granulomatous mastitis? A thirteen-year experience at a university hospital. Turk J Med Sci. 2023;53(3):744-51. doi: 10.55730/1300-0144.5637.
Alikhassi A, Azizi F, Ensani F. Imaging features of granulomatous mastitis in 36 patients with new sonographic signs. J Ultrasound. 2020;23(1):61-8. doi: 10.1007/s40477-019-00392-3.
Jafari M. Ultrasonographic Findings of Idiopathic Granulomatous Mastitis in a Case Series from a Tertiary Center: Ultrasonographic findings of IGM. Archives of Breast Cancer. 2022;9(3-SI):309-14. doi: 10.32768/abc.202293SI309-314.
Ucan ES, Alpaydin AO, Gunduz Karayazi D, Kapkac M, Takar B, Zekioglu O, et al. Tuberculous mastitis: A masquerading face of granulomatous mastitis. Tuberk Toraks. 2022;70(3):271-8. doi: 10.5578/tt.20229706.
Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging. 2016;7(4):531-9. doi: 10.1007/s13244-016-0499-0.
Al-Jarrah A, Taranikanti V, Lakhtakia R, Al-Jabri A, Sawhney S. Idiopathic Granulomatous Mastitis: Diagnostic strategy and therapeutic implications in Omani patients. Sultan Qaboos Univ Med J. 2013;13(2):241-7. doi: 10.12816/0003229.
Rajendran D, Chew BS, Wong MW, Cheong YT. Chronic granulomatous mastitis with axillary lymphadenopathy in a nulliparous woman. Med J Malaysia. 2019;74(6):564-5. doi: NA.
Dilaveri C, Degnim A, Lee C, DeSimone D, Moldoveanu D, Ghosh K. Idiopathic Granulomatous Mastitis. Breast J. 2024;2024:6693720. doi: 10.1155/2024/6693720.
De Falco M, Parmeggiani U, Oliva G, Piatto A, Allocca A, Accardo M, et al. [Granulomatous mastitis: diagnostic and therapeutic problems. Case report and review of the literature]. G Chir. 2006;27(11-12):422-7. doi: NA.
Kadivar M, Rashidian S, Jolaii A, Dabiran S. the frequency of idiopathic granulomatous mastitis and the underlying factors in recent 5-year period. RJMS. 2016;23(143):18-26. doi: NA
Topete A, Carrasco O, Barrera G, Garzón J, Gutierrez E, Márquez C, et al. Granulomatous mastitis: Incidence and experience in a Mexican institute. Journal of Biosciences and Medicines. 2019;7(06):24. doi: https://doi.org/10.4236/jbm.2019.76003.
Omranipour R, Mohammadi S-F, Samimi P. Idiopathic granulomatous lobular mastitis-report of 43 cases from iran; introducing a preliminary clinical practice guideline. Breast care. 2013;8(6):439-43. doi: 10.1159/000357320.
Altintoprak F, Karakece E, Kivilcim T, Dikicier E, Cakmak G, Celebi F, et al. Idiopathic granulomatous mastitis: an autoimmune disease? ScientificWorldJournal. 2013;2013(1):148727. doi: 10.1155/2013/148727.
Pluguez-Turull CW, Nanyes JE, Quintero CJ, Alizai H, Mais DD, Kist KA, et al. Idiopathic Granulomatous Mastitis: Manifestations at Multimodality Imaging and Pitfalls. Radiographics. 2018;38(2):330-56. doi: 10.1148/rg.2018170095.
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