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Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis

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Abstract

Idiopathic granulomatous mastitis (IGM) is an inflammatory disease of the breasts with an unknown etiology. Corticosteroids are one the primary options for treating this disease, but the results of previous studies concerning their efficacy have been controversial. We, therefore, decided to assess the effectiveness of corticosteroids on IGM using a systematic review and meta-analysis. We conducted a systematic search using MeSH terms and all relevant keywords in PubMed, EMBASE, Cochrane Library and Web of Science until May 21, 2019. Data were analyzed using the Comprehensive Meta-Analysis (CMA) V.2 software program and presented as the event rate, risk ratio (RR) and risk difference (RD). Twelve studies including 559 IGM patients were entered into the meta-analysis. Our analysis showed that the RR and RD of recurrence in the steroid-only group compared with the surgery-only group were 2.99 (95% confidence interval [CI] 0.28–31.33) and 0.14 (95% CI − 0.01–0.30), respectively, showing no statistical significance. The meta-analysis of the steroid-only group and steroid + surgery group showed that the RR of recurrence was 6.13 (95% CI 0.41–81.62) with no significance. However, the meta-analysis of the RD showed that the risk of recurrence in the steroid group was significantly higher than that in the steroids + surgery group (RD: 0.28, 95% CI 0.11–0.44). This meta-analysis showed that managing IGM with only steroids may be less effective than the combination of steroids and surgery. This combination approach may result in a lower rate of recurrence and side effects in these patients.

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References

  1. Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol. 2016;12(11):1381–94.

    Article  CAS  Google Scholar 

  2. Kessler E, Wolloch Y. Granulomatous mastitis: a lesion clinically simulating carcinoma. Am J Clin Pathol. 1972;58(6):642–6.

    Article  CAS  Google Scholar 

  3. Kadivar M, Rashidian S, Jolaii A, Dabiran S. The frequency of idiopathic granulomatous mastitis and the underlying factors in recent 5-year period. Razi J Med Sci J Iran Univ Med Sci. 2016;23(143):18–26.

    Google Scholar 

  4. Co M, Cheng VCC, Wei J, Wong SCY, Chan SMS, Shek T, et al. Idiopathic granulomatous mastitis: a 10-year study from a multicentre clinical database. Pathology. 2018;50(7):742–7.

    Article  Google Scholar 

  5. Patel RA, Strickland P, Sankara IR, Pinkston G, Many W Jr, Rodriguez M. Idiopathic granulomatous mastitis: case reports and review of literature. J Gen Intern Med. 2010;25(3):270–3.

    Article  Google Scholar 

  6. Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg. 2007;31(8):1677–81.

    Article  Google Scholar 

  7. Pandey TS, Mackinnon JC, Bressler L, Millar A, Marcus EE, Ganschow PS. Idiopathic granulomatous mastitis—a prospective study of 49 women and treatment outcomes with steroid therapy. Breast J. 2014;20(3):258–66.

    Article  Google Scholar 

  8. Freeman CM, Xia BT, Wilson GC, Lewis JD, Khan S, Lee SJ, et al. Idiopathic granulomatous mastitis: a diagnostic and therapeutic challenge. Am J Surg. 2017;214(4):701–6.

    Article  CAS  Google Scholar 

  9. Dursun M, Yilmaz S, Yahyayev A, Salmaslioglu A, Yavuz E, Igci A, et al. Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience. Radiol Med. 2012;117(4):529–38.

    Article  CAS  Google Scholar 

  10. Larsen LJH, Peyvandi B, Klipfel N, Grant E, Iyengar G. Granulomatous lobular mastitis: imaging, diagnosis, and treatment. Am J Roentgenol. 2009;193(2):574–81.

    Article  Google Scholar 

  11. DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. N Engl J Med. 1980;303(14):799–800.

    Article  CAS  Google Scholar 

  12. Wolfrum A, Kümmel S, Theuerkauf I, Pelz E, Reinisch M. Granulomatous mastitis: a therapeutic and diagnostic challenge. Breast Care. 2018;13(6):413–8.

    Article  Google Scholar 

  13. Erhan Y, Veral A, Kara E, Özdemir N, Kapkac M, Özdedeli E, et al. A clinicopthologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast. 2000;9(1):52–6.

    Article  CAS  Google Scholar 

  14. Mizrakli T, Velidedeoglu M, Yemisen M, Mete B, Kilic F, Yilmaz H, et al. Corticosteroid treatment in the management of idiopathic granulomatous mastitis to avoid unnecessary surgery. Surg Today. 2015;45(4):457–65.

    Article  CAS  Google Scholar 

  15. Skandarajah A, Marley L. Idiopathic granulomatous mastitis: a medical or surgical disease of the breast? ANZ J Surg. 2015;85(12):979–82.

    Article  Google Scholar 

  16. Akcan A, Öz AB, Dogan S, Akgün H, Akyüz M, Ok E, et al. Idiopathic granulomatous mastitis: Comparison of wide local excision with or without corticosteroid therapy. Breast Care. 2015;9(2):111–5.

    Article  Google Scholar 

  17. Akin M, Karabacak H, Esendağli G, Yavuz A, Gültekin S, Dikmen K, et al. Coexistence of idiopathic granulomatous mastitis and erythemanodosum: successful treatment with corticosteroids. Turk J Med Sci. 2017;47(5):1590–2.

    Article  CAS  Google Scholar 

  18. Altintoprak F, Kivilcim T, Yalkin O, Uzunoglu Y, Kahyaoglu Z, Dilek ON. Topical steroids are effective in the treatment of idiopathic granulomatous mastitis. World J Surg. 2015;39(11):2718–23.

    Article  Google Scholar 

  19. Çaliş H, Karakoyun R, Aslaner A, Gündüz UR, Arici C. Management of patients with idiopathic granulomatous mastitis: presentation of 13 cases. Meme Sagligi Dergisi J Breast Health. 2014;10(1):30–4.

    Article  Google Scholar 

  20. Deng JQ, Yu L, Yang Y, Feng XJ, Sun J, Liu J, et al. Steroids administered after vacuum-assisted biopsy in the management of idiopathic granulomatous mastitis. J Clin Pathol. 2017;70(10):827–31.

    Article  CAS  Google Scholar 

  21. Gunduz Y, Altintoprak F, Tatli Ayhan L, Kivilcim T, Celebi F. Effect of topical steroid treatment on idiopathic granulomatous mastitis: clinical and radiologic evaluation. Breast J. 2014;20(6):586–91.

    Article  CAS  Google Scholar 

  22. Karanlik H, Ozgur I, Simsek S, Fathalizadeh A, Tukenmez M, Sahin D, et al. Can steroids plus surgery become a first-line treatment of idiopathic granulomatous mastitis? Breast Care. 2014;9(5):338–42.

    Article  Google Scholar 

  23. Mahmodlou R, Dadkhah N, Abbasi F, Nasiri J, Valizadeh R. Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment. Electron Phys. 2017;9(9):5375–9.

    Article  Google Scholar 

  24. Sen Oran E, Gurdal SO, Yankol Y, Oznur M, Calay Z, Tunaci M, et al. Management of idiopathic granulomatous mastitis diagnosed by core biopsy: a retrospective multicenter study. Breast J. 2013;19(4):411–8.

    Article  Google Scholar 

  25. Seo HRN, 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.

    Article  Google Scholar 

  26. Yabanoglu H, Colakoglu T, Belli S, Aytac HO, Bolat FA, Pourbagher A, et al. A comparative study of conservative versus surgical treatment protocols for 77 patients with idiopathic granulomatous mastitis. Breast J. 2015;21(4):363–9.

    Article  Google Scholar 

  27. Yaghan R, Hamouri S, Ayoub NM, Yaghan L, Mazahreh T. A proposal of a clinically based classification for idiopathic granulomatous mastitis. Asian Pac J Cancer Prev APJCP. 2019;20(3):929–34.

    Article  Google Scholar 

  28. Wells GA, Tugwell P, O’Connell D, Welch V, Peterson J, Shea B, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. 2015.

  29. McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2021;12:55–61.

    Article  Google Scholar 

  30. Akbulut S, Arikanoglu Z, Senol A, Sogutcu N, Basbug M, Yeniaras E, et al. Is methotrexate an acceptable treatment in the management of idiopathic granulomatous mastitis? Arch Gynecol Obstet. 2011;284(5):1189–95.

    Article  CAS  Google Scholar 

  31. Mathew Thomas V, Alexander SA, Bindal P, Vredenburgh J. Idiopathic granulomatous mastitis-a mystery yet to be unraveled: a case series and review of literature. Cureus. 2020;12(2):e6895.

    PubMed  PubMed Central  Google Scholar 

  32. Azlina AF, Ariza Z, Arni T, Hisham AN. Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg. 2003;27(5):515–8.

    Article  Google Scholar 

  33. Kok KYY, Telisinghe PU. Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surg. 2010;8(4):197–201.

    CAS  Google Scholar 

  34. Asoglu O, Ozmen V, Karanlik H, Tunaci M, Cabioglu N, Igci A, et al. Feasibility of surgical management in patients with granulomatous mastitis. Breast J. 2005;11(2):108–14.

    Article  Google Scholar 

  35. Konan A, Kalyoncu U, Dogan I, Kılıç YA, Karakoç D, Akdogan A, et al. Combined long-term steroid and immunosuppressive treatment regimen in granulomatous mastitis. Breast Care. 2012;7(4):297–301.

    Article  Google Scholar 

  36. Donn W, Rebbeck P, Wilson C, Gilks CB. Idiopathic granulomatous mastitis. A report of three cases and review of the literature. Arch Pathol Lab Med. 1994;118(8):822–5.

    CAS  PubMed  Google Scholar 

  37. Kaviani A, Vasigh M, Omranipour R, Mahmoudzadeh H, Elahi A, Farivar L, et al. Idiopathic granulomatous mastitis: looking for the most effective therapy with the least side effects according to the severity of the disease in 374 patients in Iran. Breast J. 2019;25(4):672–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Gholamali Godazandeh & Leyla Shojaee

  2. Gastrointestinal Cancer Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran

    Reza Alizadeh-Navaei

  3. Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Amirhossein Hessami

  4. Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Amirhossein Hessami

  5. Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Amirhossein Hessami

Authors
  1. Gholamali Godazandeh
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Correspondence to Leyla Shojaee.

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Godazandeh, G., Shojaee, L., Alizadeh-Navaei, R. et al. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today 51, 1897–1905 (2021). https://doi.org/10.1007/s00595-021-02234-4

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  • DOI: https://doi.org/10.1007/s00595-021-02234-4

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