Vercoe J, Sedaghat N, Brennan M E
School of Medicine Sydney, National School of Medicine, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.
Department of Surgery, Macquarie University Hospital, North Ryde, New South Wales, Australia.
Breast J. 2025 Jan 21;2025:2592366. doi: 10.1155/tbj/2592366. eCollection 2025.
Although idiopathic granulomatous mastitis (GM) of the breast is a benign condition, it can be locally aggressive and frequently chronic, causing significant pain and distress to the patient. Treatment often involves multiple disciplines including general practice, breast surgery/physicians, rheumatology and/or immunology. Traditional options for treatment include observation, oral steroids, methotrexate and/or surgery, all with variable outcomes. A more recent alternative treatment option involves intralesional steroid injections. Using PRISMA methodology, a systematic review of intralesional steroid injection for the management of GM was conducted. Medline, PubMed, Embase and Cochrane databases were searched for original studies reporting treatment protocols and clinical outcomes, published up to the end of September 2023. Nine eligible studies reported outcomes in 474 patients undergoing treatment of GM with intralesional injections. All studies reported success (improvement in clinical and/or imaging appearance) with intralesional injections. Studies that had a comparison group showed statistically significantly fewer side effects compared to oral steroids or surgical management. The recurrence rate was less for intralesional injections than for other treatments in all studies except one. No studies included patient-reported outcomes. There is consistent evidence for the safety, efficacy and low recurrence rate with intralesional steroid injections for GM. The existing literature is heterogenous with respect to injection protocols, and the optimal protocol is unclear. Future research should compare the various steroid agents and dose/frequency of administration. Future studies should include cost analysis and patient-reported outcomes to ensure that the treatment is cost-effective and acceptable to people with idiopathic GM.
尽管乳腺特发性肉芽肿性乳腺炎（GM）是一种良性疾病，但它可能具有局部侵袭性且常常呈慢性，给患者带来极大的疼痛和困扰。治疗通常涉及多个学科，包括全科医疗、乳腺外科/内科医生、风湿病学和/或免疫学。传统的治疗选择包括观察、口服类固醇、甲氨蝶呤和/或手术，所有这些治疗的效果各不相同。一种较新的替代治疗选择是病灶内注射类固醇。采用PRISMA方法，对病灶内注射类固醇治疗GM进行了系统评价。检索了Medline、PubMed、Embase和Cochrane数据库，以查找截至2023年9月底发表的报告治疗方案和临床结果的原始研究。9项符合条件的研究报告了474例接受病灶内注射治疗GM患者的结果。所有研究均报告病灶内注射取得了成功（临床和/或影像学表现有所改善）。设有对照组的研究显示，与口服类固醇或手术治疗相比，副作用在统计学上显著更少。除一项研究外，所有研究中病灶内注射的复发率均低于其他治疗方法。没有研究纳入患者报告的结果。有一致的证据表明病灶内注射类固醇治疗GM具有安全性、有效性和低复发率。现有文献在注射方案方面存在异质性，最佳方案尚不清楚。未来的研究应比较各种类固醇药物以及给药剂量/频率。未来的研究应包括成本分析和患者报告的结果以确保该治疗具有成本效益且为特发性GM患者所接受。
