Management Patterns of Idiopathic Granulomatous Mastitis at a Safety-Net Hospital
*Akshay Ravandur , Anna Kobzeva-Herzog MD, *Sophie Chung MD, *Tracy Battaglia MD MPH, Michael R. Cassidy MD, *Amy Fitzpatrick MD, *Jordana Phillips MD, *Christine Prifti MD, *Priscilla Slanetz MD MPH, *Michael York MD, *Andrea Merrill MD
Boston Medical Center, Boston, MA
Background: Idiopathic granulomatous mastitis (IGM) is a rare, benign condition that is poorly understood. Diagnosis and management are complex, with many institutions lacking standardized protocols. This study aimed to describe the demographics, clinical features, and treatment patterns of women with IGM at a safety-net hospital to guide the creation of a multi-disciplinary treatment protocol.
Study Design: A single-center retrospective chart review of women 18+ with biopsy-proven or suspected IGM diagnosis at a tertiary-care, urban, academic, safety-net hospital from 2016 to 2022.
Results: There were 40 patients with IGM. Average age was 37 years old. The majority of patients were Hispanic (60%), multiparous (60%), and had previously breastfed (60%). A plurality were non-White (47.5%) and had a BMI over 30 (45%). Palpable mass (97.5%), pain (90%), and erythema (57.5%) were the most frequently documented symptoms of IGM. On imaging, mammography frequently demonstrated a mass (50%), asymmetry (32.5%), and distortion (17.5%), while the most common findings on ultrasonography were mass (88%) and increased vascularity (50%). A majority of patients were classified as Category 4 (70%) under the Breast Imaging Reporting & Data System (BI-RADS) prior to biopsy. The median number of days between initial presentation and biopsy was 27.5. Patients with IGM were often seen by physicians from more than two specialties (55%), and were prescribed antibiotics (75%), oral steroids (35%), and methotrexate (37.5%) for treatment. Antibiotics were prescribed for an average of 22.8 days, and the most common agents were doxycycline (47.5%) and cefalexin (40%). Just under half (47.5%) of patients had documented resolution of IGM, with an average time to resolution of 9.58 months. A minority of patients (10%) experienced recurrence of IGM after 6 months.
Conclusions: Diagnosis and treatment of IGM is complex. Our patients had similar demographics compared to prior studies including an increased rate of IGM among Hispanic and previously lactating patients. At our institution, patients frequently saw multiple providers, were treated with multiple regimens, and waited 28 days for biopsy confirmation. Given the variation in management, we recommend a multi-disciplinary approach to create a standard protocol for IGM to expedite diagnosis and management.
This table includes the following case characteristics: age, race, ethnicity, BMI, lactation status, time to diagnosis, setting of initial presentation, specialists seen, and days of antibiotics.
This table shows the imaging findings and reported symptoms for the cases of IGM at our hospital.
This table includes the treatments, time to resolution, and recurrence of IGM cases at our hospital.
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