Liu Jia, Lin Wei-Yi, Wang Qiu-Zhou, Yang Xiao-Qin, Lv Qing, Tan Qiu-Wen
Division of Breast Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Breast Center, West China Hospital, Sichuan University, Chengdu, China.
Gland Surg. 2025 Apr 30;14(4):646-657. doi: 10.21037/gs-2024-557. Epub 2025 Apr 25.
Granulomatous mastitis is an infrequent and intricate ailment. Limited knowledge exists regarding how granulomatous mastitis progresses and its impact on disease management. We aim to prospectively capture symptoms in the general population to accurately ascertain the duration of illness and the prevalence of long-lasting symptoms.
This study reports data from 169 prospectively enrolled real-world patients with pathologically confirmed granulomatous mastitis. Patients were enrolled after screening according to the inclusion and exclusion criteria. Patients were followed-up every 2-4 weeks during treatment, then every 3-6 months (Year 1) and 6-12 months (Year 2). Outcomes included symptom resolution, disease course, and relapse. Associations between clinical variables and outcomes were assessed using appropriate statistical models, with significance defined as P<0.05.
The median disease course of granulomatous mastitis was 257 days (range, 55-1,500 days), with the majority of disease regression occurring within a span of 6 months subsequent to diagnosis; 72.78% of patients preferred steroids as the initial treatment. The use of steroids was associated with a shorter disease course after adjusting for age, lump size, abscess, and sinus formation (P=0.02). Abscess formation was observed in 58.57% of patients. Notably, abscess formation during disease progression contributed to a prolonged disease course (358.67 278.24 days, P=0.03).
Our findings highlighted the heterogeneity of granulomatous mastitis disease course and emphasized the importance of steroid usage in shortening disease course. Avoiding abscess and sinus formation, early steroid usage during granulomatous mastitis treatment might be beneficial. These evidences provide novel insights and supports the use of steroids in patients with granulomatous mastitis for modulating their immune response. Studies are urgently needed to further elucidate the role of steroid in granulomatous mastitis management.
肉芽肿性乳腺炎是一种罕见且复杂的疾病。关于肉芽肿性乳腺炎如何进展及其对疾病管理的影响，目前了解有限。我们旨在前瞻性地收集普通人群中的症状，以准确确定疾病持续时间和长期症状的患病率。
本研究报告了169例经病理证实的肉芽肿性乳腺炎的前瞻性入组真实世界患者的数据。患者根据纳入和排除标准筛选后入组。治疗期间每2 - 4周随访一次，然后在第1年每3 - 6个月随访一次，第2年每6 - 12个月随访一次。观察指标包括症状缓解、病程和复发情况。使用适当的统计模型评估临床变量与观察指标之间的关联，显著性定义为P<0.05。
肉芽肿性乳腺炎的中位病程为257天（范围为55 - 1500天），大多数疾病消退发生在诊断后的6个月内；72.78%的患者首选类固醇作为初始治疗。在调整年龄、肿块大小、脓肿和窦道形成因素后，使用类固醇与较短的病程相关（P = 0.02）。58.57%的患者出现脓肿形成。值得注意的是，疾病进展过程中脓肿形成导致病程延长（358.67±278.24天，P = 0.03）。
我们的研究结果突出了肉芽肿性乳腺炎病程的异质性，并强调了使用类固醇在缩短病程中的重要性。在肉芽肿性乳腺炎治疗期间，避免脓肿和窦道形成，早期使用类固醇可能有益。这些证据提供了新的见解，并支持在肉芽肿性乳腺炎患者中使用类固醇来调节其免疫反应。迫切需要开展研究以进一步阐明类固醇在肉芽肿性乳腺炎管理中的作用。
