Toktas Osman, Konca Can, Trabulus Didem Can, Soyder Aykut, Koksal Hande, Karanlik Hasan, Kamali Polat Ayfer, Ozbas Serdar, Yormaz Serdar, Isik Arda, Sezgin Efe, Soran Atilla
Department of Surgery, Medical Faculty, Van Yuzuncu Yıl University, Van, Turkey.
Department of Surgery, Medical Faculty, Ankara University, Ankara, Turkey.
Breast Care (Basel). 2021 Apr;16(2):181-187. doi: 10.1159/000507951. Epub 2020 Jun 30.
Idiopathic granulomatous mastitis (IGM) is a rare form of nonlactational mastitis. Due to the small number of case series and consequently inadequate prospective studies, there is still no consensus on the optimal treatment of IGM. In this study, we aimed to compare the efficacy of intralesional steroid injection with concomitant topical steroids to systemic steroid therapy only in the treatment of noncomplicated IGM.
Between June 2015 and April 2018, the patients' data was prospectively collected and analyzed retrospectively. The study included a total of 78 female patients diagnosed with IGM. Patients were divided into 2 groups: the local steroid treatment group (intralesional steroid injection with topical steroid administration; group 1, = 46) and the peroral systemic steroid treatment group (group 2, = 32). Response to the therapy, side effects, recurrence, the need for surgical treatment, and complication rates were compared.
Forty-three patients (93.5%) in group 1 achieved a partial or complete response compared to 23 patients (71.9%) in group 2 after 3 months; this difference was significant ( = 0.012). The recurrence rates were significantly lower in group 1 (8.7%) compared to group 2 (46.9%; = 0.001), and the need for surgical treatment was significantly less in group 1 (2.2%) than in group 2 (9.4%; = 0.001). While the complication rates were similar between groups, a higher rate of systemic side effects was observed in group 2.
Based on the results of our study, combined steroid injection and topical steroid treatment in IGM is as effective as systemic steroid treatment. We suggest that this combination therapy of topical steroids and local steroid injection should be used as first-line therapy in patients with noncomplicated IGM.
特发性肉芽肿性乳腺炎（IGM）是一种罕见的非哺乳期乳腺炎。由于病例系列数量较少，因此前瞻性研究不足，目前对于IGM的最佳治疗方法仍未达成共识。在本研究中，我们旨在比较病灶内注射类固醇并联合局部使用类固醇与仅采用全身类固醇治疗非复杂性IGM的疗效。
2015年6月至2018年4月期间，前瞻性收集患者数据并进行回顾性分析。该研究共纳入78例诊断为IGM的女性患者。患者分为两组：局部类固醇治疗组（病灶内注射类固醇并局部使用类固醇；第1组，n = 46）和口服全身类固醇治疗组（第2组，n = 32）。比较两组对治疗的反应、副作用、复发情况、手术治疗需求及并发症发生率。
3个月后，第1组43例患者（93.5%）达到部分或完全缓解，而第2组为23例患者（71.9%）；差异具有统计学意义（P = 0.012）。第1组的复发率（8.7%）显著低于第2组（46.9%；P = 0.001），且第1组的手术治疗需求（2.2%）明显少于第2组（9.4%；P = 0.001）。虽然两组并发症发生率相似，但第2组全身副作用发生率更高。
基于我们的研究结果，IGM中联合类固醇注射和局部类固醇治疗与全身类固醇治疗同样有效。我们建议，对于非复杂性IGM患者，这种局部类固醇与病灶内类固醇注射的联合治疗应作为一线治疗方法。
