Evaluation of the efficacy of intralesional triamcinolone injection therapy in patients with granulomatous mastitis: a comparative study with oral methylprednisolone

Year 2023, , 473 - 478, 27.10.2023

Tuba Mert

https://doi.org/10.38053/acmj.1338069

Abstract

Aims: This study aims to compare the efficacy of oral steroid therapy with the combination of topical and intralesional steroid (TILS) therapy in patients with granulomatous mastitis (GM).
Methods: This is a single-center retrospective longitudinal study. Women with a diagnosis of GM who applied to Medipol Universty Pendik Hospital General Surgery Clinic between January 2020 and April 2022 were included in the study. Participants received TILS or peroral steroid (POS) treatment in sequential order, and each patient received only one of the treatment options. Participants were evaluated by physical examination, USG, and radiography before and after treatment to assess lesion size, side, number of foci, skin characteristics, and the presence of pain. The clinical and radiological findings were compared betwen the groups at the end of the 6-month follow-up and the participants were followed up for the next 12 months to demonstrate the efficacy.
Results: A total of 52 women participated in the study, with 26 in the POS group and 26 in the TILS group. The mean age was 33.33+6.94 years and similar between the two groups (p=0.831). Three patients (11.53%) in the TILS group and 7 patients (26.92%) in the POS group were nonresponders to treatment (p=0.159). Given the nonresponders, GM lesions persisted in one patient (3.84%) in the TILS group and 3 patients (11.53%) in the POS group at the end of the study (p=0.610). At the end of the 12-month follow-up, five patients (19.2%) in the TILS group and 20 patients (76.9%) in the POS group who achieved a complete remission at the posttreatment 6 months experienced disease recurrence (p<0.001). Cox regression analysis revealed that only foci in the breast (p=0.043) and abscess formation (p=0.018) were independent risk factors for GM recurrence. In the TILS group, intervention-related complications were not observed while blood pressure and glucose elevation, weight gain, and edema were found in the POS group (p<0.05).
Conclusion: TILS provides similar efficacy to systemic steroid therapy, with a lower recurrence rate and potential for side effects.

Keywords

Granulomatous mastitis, Intralesional steroid, Breast abscess

References

• Bi J, Li Z, Lin X, et al. Etiology of granulomatous lobular mastitis based on metagenomic next-generation sequencing. Int J Infect Dis. 2021;113:243-250.
• Barreto DS, Sedgwick EL, Nagi CS, Benveniste AP. Granulomatous mastitis: etiology, imaging, pathology, treatment, and clinical findings. Breast Cancer Res Treat. 2018;171(3): 527-534.
• Benson JR, Dumitru D. Idiopathic granulomatous mastitis: presentation, investigation and management. Future Oncol. 2016;12(11):1381-1394.
• Wolfrum A, Kümmel S, Theuerkauf I, Pelz E, Reinisch M. Granulomatous mastitis: a therapeutic and diagnostic challenge. Breast Care (Basel). 2018;13(6):413-418.
• Lei X, Chen K, Zhu L, Song E, Su F, Li S. Treatments for idiopathic granulomatous mastitis: systematic review and meta-analysis. Breastfeed Med. 2017;12(7):415-421.
• Sripathi S, Ayachit A, Bala A, Kadavigere R, Kumar S. Idiopathic granulomatous mastitis: a diagnostic dilemma for the breast radiologist. Insights Imaging. 2016;7(4):523-529.
• Yin Y, Liu X, Meng Q, Han X, Zhang H, Lv Y. Idiopathic granulomatous mastitis: etiology, clinical manifestation, diagnosis and treatment. J Invest Surg. 2022;35(3):709-720.
• Wang J, Zhang Y, Lu X, et al. Idiopathic granulomatous mastitis with skin rupture: a retrospective cohort study of 200 patients who underwent surgical and nonsurgical treatment. J Invest Surg. 2021;34(7):810-815.
• Tang ELS, Ho CSB, Chan PMY, Chen JJC, Goh MH, Tan EY. The therapeutic dilemma of idiopathic granulomatous mastitis. Ann Acad Med Singap. 2021;50(8):598-605.
• Alsaleh N. Assertive clinical practice in managing patients with idiopathic granulomatous mastitis: review of literature. Ann Med Surg (Lond). 2021;70:102792.
• Godazandeh G, Shojaee L, Alizadeh-Navaei R, Hessami A. Corticosteroids in idiopathic granulomatous mastitis: a systematic review and meta-analysis. Surg Today. 2021;51(12):1897-1905.
• Zhou F, Liu L, Liu L, et al. Comparison of conservative versus surgical treatment protocols in treating idiopathic granulomatous mastitis: a meta-analysis. Breast Care (Basel). 2020;15(4):415-420.
• Al-Khaffaf B, Knox F, Bundred NJ. Idiopathic granulomatous mastitis: a 25-year experience. J Am Coll Surg. 2008;206(2):269-273.
• Co M, Cheng VCC, Wei J, et al. Idiopathic granulomatous mastitis: a 10-year study from a multicentre clinical database. Pathology. 2018;50(7):742-747.
• Wong SCY, Poon RWS, Chen JHK, et al. Corynebacterium kroppenstedtii is an emerging cause of mastitis especially in patients with psychiatric illness on antipsychotic medication. Open Forum Infect Dis. 2017;4(2):ofx096.
• Freeman CM, Xia BT, Wilson GC, et al. Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge. Am J Surg. 2017;214(4):701-706.
• Toktas O, Konca C, Trabulus DC, et al. A Novel first-line treatment alternative for noncomplicated idiopathic granulomatous mastitis: combined intralesional steroid injection with topical steroid administration. Breast Care (Basel). 2021;16(2):181-187.
• DeHertogh DA, Rossof AH, Harris AA, Economou SG. Prednisone management of granulomatous mastitis. N Engl J Med. 1980;303(14):799-800.
• Azlina AF, Ariza Z, Arni T, Hisham AN. Chronic granulomatous mastitis: diagnostic and therapeutic considerations. World J Surg. 2003;27(5):515-518.
• Kok KY, Telisinghe PU. Granulomatous mastitis: presentation, treatment and outcome in 43 patients. Surgeon. 2010;8(4):197-201.
• Yildirim E, Kayadibi Y, Bektas S, et al. Comparison of the efficiency of systemic therapy and intralesional steroid administration in the treatment of idiopathic granulomatous mastitis. the novel treatment for granulomatous mastitis. Ann Ital Chir. 2021;92:234-241.
• Akcan A, Öz AB, Dogan S, et al. idiopathic granulomatous mastitis: comparison of wide local excision with or without corticosteroid therapy. Breast Care. 2014;9(2):111-115.
• Néel A, Hello M, Cottereau A, et al. Long-term outcome in idiopathic granulomatous mastitis: a western multicentre study. QJM. 2013;106(5):433-441.
• Uysal E, Soran A, Sezgin E. Granulomatous Mastitis Study Group. Factors related to recurrence of idiopathic granulomatous mastitis: what do we learn from a multicentre study? ANZ J Surg. 2018;88(6):635-639.
• Basim P, Argun D, Argun F. Risk factors for idiopathic granulomatous mastitis recurrence after patient-tailored treatment: do we need an escalating treatment algorithm? Breast Care (Basel). 2022;17(2):172-179.