The role of clinical and radiological risk factors and triglyceride-glucose index in predicting recurrence of idiopathic granulomatous mastitis

Year 2024, Volume: 5 Issue: 5, 247 - 255, 26.10.2024

Semih Sağlik

Abstract

Aims: Idiopathic granulomatous mastitis (IGM) is a rare breast disease characterised by granulomatous inflammation that is clinically and radiologically similar to breast cancer. The main challenge in treating IGM is the development of treatment resistance and recurrence. Many studies have been carried out in the literature to identify markers of recurrence in this disease, but no satisfactory results have been obtained. The aim of this study was to determine the role of clinical, radiological and laboratory parameters in predicting recurrence in patients with IGM and to evaluate the relationship between the triglyceride-glucose (TyG) index and IGM recurrence.
Methods: In this study, the electronic medical records of 92 patients who were histopathologically diagnosed with IGM between January 2016 and February 2024 were retrospectively reviewed. Patients were divided into two groups according to recurrence status. Clinical, radiological and laboratory parameters were compared between groups.
Results: Recurrence was detected in 26.1% of the patients included in the study and the average follow-up period was 27.6±4.6 months. No statistically significant difference was found between the two groups with regard to age, follow-up time, menopausal status, breastfeeding, oral contraceptive use, smoking history, parity and pathological diagnosis (p>0.05 for all). In univariate analysis, axillary lymphadenopathy, long duration of breastfeeding, low serum albumin globulin ratio and high TyG index were identified as risk factors for IGM recurrence. In multivariate regression analysis, long duration of breastfeeding (p=0.042, OR: 4.12; 95% confidence interval (CI), 1.05-16.11) and high TyG index
(p=0.005, OR: 5.75; 95% confidence interval (CI), 1.69-19.54) were found to be independent risk factors for recurrence.
Conclusion: Study results suggest that a high TyG index at initial presentation and long duration of breastfeeding increase the risk of recurrence in IGM patients. Therefore, questioning the breastfeeding history at the time of admission and determining and analyzing the TyG index can identify patients at high risk for recurrence.

Keywords

Idiopathic granulomatous mastitis, recurrence, ultrasonography, triglyceride-glucose index, axillary lymphadenopathy, breastfeeding duration

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethics Committee Approval was obtained from the Siirt University Non-Invasive Ethics Committee (Date: 22.02.2024, Decision No: 101661).

Thanks

The author would like to thank Dr. Enver Ay from the Department of General Surgery for her help in the preparation of this study.

İdiyopatik granülomatöz mastit nüksünü öngörmede klinik ve radyolojik risk faktörleri ile trigliserid-glukoz indeksinin rolü

Abstract

Amaç
İdiyopatik granülomatöz mastit (IGM), klinik ve radyolojik olarak meme kanseri ile benzerlik gösteren granülomatöz inflamasyon ile seyreden nadir görülen meme hastalığıdır. IGM tedavisindeki en önemli zorluk tedaviye direnç ve nüks gelişimidir. Literatürde bu hastalığın nüks belirteçlerini belirlemeye yönelik birçok çalışma yapılmıştır fakat tatmin edici bir sonuca varılamamıştır. Bu çalışmada idiopatik granülomatöz mastit hastalarında nüksü öngörmede klinik, radyolojik ve laboratuvar parametrelerin rolünün belirlenmesi ve trigliserit-glikoz (TyG) indeksi ile IGM nüksü arasındaki ilişkinin değerlendirmesi amaçlanmıştır.
Hastalar ve Yöntemler
Bu çalışmada Ocak 2016 ile Şubat 2024 tarihleri arasında histopatolojik olarak IGM tanısı alan 92 hastanın elektronik tıbbi kayıtları geriye dönük incelendi. Hastalar nüks durumuna göre iki gruba ayrıldı. Gruplar arası klinik, radyolojik ve laboratuvar parametreleri karşılaştırıldı.
Bulgular
Çalışmaya dahil edilen hastaların %261’inde nüks saptandı ve ortalama takip süresi 27.6±4.6 ay idi. Her iki grup arasında yaş, takip süresi, menapozal durum, emzirme, oral kontraseptif, sigara kullanım öyküsü, parite, patolojik tanı ve tedavi şekli arasında istatiksel olarak anlamlı farklılık saptanmadı (tümü için p >0.05). Tek değişkenli analizde axiller lymphadenopathy, uzun emzirme süresi, düşük serum albümin globülin oranı ve yüksek TyG indeksi IGM nüksünde risk faktörleri olarak belirlendi. Çok değişkenli regresyon analizde ise uzun emzirme süresinin (p =0.042, OR: 4.12; 95% confidence interval (CI), 1.05-16.11) ve yüksek TyG indeksinin (p =0.005, OR: 5.75; 95% confidence interval (CI), 1.69-19.54) nüks acısından bağımsız risk faktörleri oldukları belirlendi.
Sonuç
Çalışma bulguları, ilk başvuru sırasında yüksek TyG indeksinin ve uzun emzirme süresinin IGM hastalarında nüks riskini arttırdığını göstermektedir. Bu nedenle başvuru sırasında emzirme öyküsünün iyi sorgulanması ve TyG indeksinin belirlenip analiz edilmesi nüks açısından yüksek risk altındaki hastaları belirleyebilir.

Keywords

İdiyopatik granülomatöz mastit, nüks, trigliserit-glikoz indeksi, axiller lenfadenopati, emzirme süresi

References

• Martinez‐Ramos D, Simon‐Monterde L, Suelves‐Piqueres C, et al. Idiopathic granulomatous mastitis: a systematic review of 3060 patients. Breast J. 2019;25(6):1245-1250. doi:10.1111/tbj.13446
• Altintoprak F, Kivilcim T, Ozkan OV. Aetiology of idiopathic granulomatous mastitis. World J Clin Cases: WJCC. 2014;2(12): 852. doi: 10.12998/wjcc.v2.i12.852
• 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. doi: 10.1111/ans.14115
• Ciftci AB, Bük ÖF, Yemez K, Polat S, Yazıcıoğlu İM. Risk factors and the role of the albumin-to-globulin ratio in predicting recurrence among patients with idiopathic granulomatous mastitis. J Inflamm Res. 2022;5401-5412. doi: 10.2147/JIR.S377804
• Yılmaz TU, Gürel B, Güler SA, et al. Scoring idiopathic granulomatous mastitis: an effective system for predicting recurrence? Eur J Breast Health. 2018;14:112–116. doi: 10.5152/ejbh.2018.3709
• Aghajanzadeh M, Hassanzadeh R, Alizadeh Sefat S, et al. Granulomatous mastitis: presentations, diagnosis, treatment and outcome in 206 patients from the north of Iran Breast. 2015;24:456–460. doi: 10.1016/j.breast.2015.04.003
• Baslaim MM, Khayat HA, Al-Amoudi SA. Idiopathic granulomatous mastitis: a heterogeneous disease with variable clinical presentation. World J Surg 2007;31:1677-1681. doi:10. 1007/s00268-007-9116-1
• Su J, Li Z, Huang M, et al. Triglyceride glucose index for the detection of the severity of coronary artery disease in different glucose metabolic states in patients with coronary heart disease: a RCSCD-TCM study in China. Cardiovasc Diabetol. 2022; 21(1): p.96. doi:10.1186/s12933-022-01523-7
• Zhang S, Du T, Zhang J et al. The triglyceride and glucose index (TyG) is an effective biomarker to identify nonalcoholic fatty liver disease. Lipids Health Dis. 2017;16,1-8. doi: 10.1186/s12944-017-0409-6
• Sterling RK, King WC, Khalili M, Kleiner DE, Hinerman AS, Sulkowski M. Performance of serum-based scores for ıdentification of mild hepatic steatosis in hbv mono-infected and HBV–HIV Co-infected adults. Digest Dis Sci. 2021;1-13. doi:10.1007/s10620-021-06860-3
• Ren H, Yang Y, Wang F, et al. Association of the insulin resistance marker TyG index with the severity and mortality of COVID-19. Cardiovasc Diabetol. 2020;19:1-8. doi:10.1186/s12933-020-01035 -2
• Wei Y, Guo J. High triglyceride–glucose ındex ıs associated with poor prognosis in patients with acute pancreatitis. Digest Dis Sci. 2023;68(3):978-987. doi:10.1007/s10620-022-07567-9
• Fang Y, Xiong B, Shang X, Yang F, Yin Y, Sun Z. Triglyceride-glucose index predicts sepsis-associated acute kidney injury and length of stay in sepsis: a MIMIC-IV cohort study. Heliyon. 2024; 10(7). doi:10.1016/j.heliyon.2024.e29257
• Lin HY, Zhang XJ, Liu YM, Geng LY, Guan LY, Li, XH. Comparison of the triglyceride glucose index and blood leukocyte indices as predictors of metabolic syndrome in healthy Chinese population. Sci Rep. 2021;11(1):p.10036. doi:10.1038/s41598-021-89494-9
• Yan F, Yan S, Wang J, et al. Association between triglyceride glucose index and risk of cerebrovascular disease: systematic review and meta-analysis. Cardiovasc Diabetol. 2022;21(1):p.226. doi:10.1186/s12933-022-01664-9
• Cai C, Chen C, Lin X, et al. An analysis of the relationship of triglyceride glucose index with gastric cancer prognosis: a retrospective study. Cancer Med. 2024; 13(3):e6837. doi:10.1002/cam4.6837
• Shi H, Zhou L, Yang S, Zhou H. The relationship between triglyceride and glycose (TyG) index and the risk of gynaecologic and breast cancers. Clin Nutr ESPEN. 2022;51:345–52. doi:10. 1016/j.clnesp.2022.08.004
• Alkurt EG, Ozkan MB, Turhan VB. Predictive value of triglyceride/glucose index (TyG) in predicting breast cancer in patients with breast mass. Eur Rev Med Pharmacol Sci. 2022; 26:4671–6. doi: 10.26355/eurrev_202207_29191
• Zhang J, Yin B, Xi Y, Bai Y. Triglyceride-glucose index is a risk factor for breast cancer in China: a cross-sectional study. Lipids Health Dis. 2024;23(1):29. doi:10.1186/s12944-024-02008-0
• Liu X, Tan Z, Huang Y, et al. Relationship between the triglyceride-glucose index and risk of cardiovascular diseases and mortality in the general population: a systematic review and meta-analysis. Cardiovasc Diabetol. 2022;21:124. doi:10.1186/s12933-022-01546-0
• Bedi DG, Krishnamurthy R, Krishnamurthy S et al. Cortical morphologic features of axillary lymph nodes as a predictor of metastasis in breast cancer: in vitro sonographic study. AJR. 2008; 191(3):646-652. doi:10.2214/AJR.07.2460
• Azizi A, Prasath V, Canner J, et al. Idiopathic granulomatous mastitis: management and predictors of recurrence in 474 patients. Breast J. 2020; 26(7):1358-1362. doi: 10.1111/tbj.13822
• Zhang B, Peng A, Li S, Li F, Wan J, Lu J. Association of triglyceride-glucose index and neutrophil-to-lymphocyte ratio with coronary artery disease. BMC Cardiovasc Disord. 2023; 23(1), 534. doi: 10.1186/s12872-023-03564-6
• Hao B, Lyu L, Xu J, et al. The relationship between triglyceride-glucose index and prospective key clinical outcomes in patients hospitalised for coronary artery disease. Cardiovasc Diabetol. 2024;23(1):40. doi:10.1186/s12933-024-02132-2
• Yan Y, Zhou L, La R, et al. The association between triglyceride glucose index and arthritis: a population-based study. Lipids Health Dis. 2023;22(1):132. doi: 10.1186/s12944-023-01899-9
• Hu M, Zhang Y, Guo X, et al. Hyperandrogenism and insulin resistance induce gravid uterine defects in association with mitochondrial dysfunction and aberrant reactive oxygen species production. Am J Physiol Endocrinol Metab. 2019;316:E794–e809. doi: 10.1152/ajpendo.00359.2018
• Cetinkaya OA, Celik SU, Terzioglu SG, Eroglu A. The predictive value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with recurrent idiopathic granulomatous mastitis. Eur J Breast Health. 2020;16(1):61–65. doi:10.5152/ejbh.2019.5187
• Kargin S, Turan E, Esen HH, Çetin Kargin N. Role of pre-treatment neutrophil-lymphocyte ratio in the prediction of recurrences after granulomatous mastitis treatment. Turk Klinikleri J Med Sci. 2020;40(1):46–51. doi:10.5336/medsci. 2019-66835
• 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. 2022;17(2):172–179. doi:10.1159/000517399
• Velidedeoglu M, Umman V, Kilic F, et al. Idiopathic granulomatous mastitis: introducing a diagnostic algorithm based on 5 years of follow-up of 152 cases from Turkey and a review of the literature. Surg Today. 2022;52(4):668–680. doi:10.1007/s00595-021-02367-6
• Huang YM, Lo C, Cheng CF, Lu CH, Hsieh SC, Li KJ. Serum C-reactive protein and interleukin-6 levels as biomarkers for disease severity and clinical outcomes in patients with idiopathic granulomatous mastitis. J Clin Med. 2021;10:10. doi:10.3390/jcm 10102077
• Huang Y, Wu H. A retrospective analysis of recurrence risk factors for granulomatous lobular mastitis in 130 patients: more attention should be paied to prolactin level. Ann Palliat Med 2021;10(3):2824831-2822831. doi:10.21037/apm-20-1972
• Tasci HI, Turk E, Erinanc OH, Erkan S, Gundogdu R, Karagulle E. Factors affecting recurrence of ıdiopathic granulomatous mastitis. JCPSP. 2022; 32(2):161-166. doi:10.29271/jcpsp.2022.02.161
• Abbi B, Sanghavi N, Lanjewar S et al. Clinical, histological features, and predictors of relapse in patients with idiopathic granulomatous mastitis. Medicine. 2023;102(44):e35679. doi:10. 1097/MD.0000000000035679
• Çetinkaya ÖA, Çelik SU, Terzioğlu SG, Eroğlu A. The predictive value of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in patients with recurrent idiopathic granulomatous mastitis. Eur J Breast Health. 2020;16(1):61. doi: 10.5152/ejbh.2019.5187
• Fattahi AS, Amini G, Sajedi F, Mehrad-Majd H. Factors affecting recurrence of idiopathic granulomatous mastitis: a systematic review. Breast J. 2023;2023. doi:10.1155/2023/9947797
• Aydın HO, Baykal A, Konan A, Kaynaroğlu V. Idiopathic granulomatous mastitis: factors influencing recovery and recurrence. EuRJ. 2019;5(5):768-775. doi:10.18621/eurj.424016
• Oltean HN, Soliman AS, Omar OS, et al. Risk factors for chronic mastitis in Morocco and Egypt. Int J Inf. 2013:184921. doi:10. 1155/2013/184921
• Erhan Y, Veral A, Kara E, et al. A clinicopathologic study of a rare clinical entity mimicking breast carcinoma: idiopathic granulomatous mastitis. Breast. 2000;9:52–56. doi:10.1054/brst. 1999.0072
• Verfaillie G, Breucq C, Sacre R, Bourgain C, Lamote J. Granulomatous lobular mastitis: a rare chronic inflammatory disease of the breast which can mimic breast carcinoma. Acta Chir Belg. 2006;106:222–224. doi:10.1080/00015458.2006.11679876
• Akcan A, Akyildiz H, Deneme MA, Akgun H, Aritas Y: Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem. World J Surg. 2006;30:1403-1409. doi:10. 1007/s00268-005-0476-0
• Fazzio RT, Shah SS, Sandhu NP, Glazebrook KN. Idiopathic granulomatous mastitis: imaging update and review. Insights Imaging. 2016;7(4):531–539. https://doi.org/10.1007/s13244-016-0499-0
• Bani-Hani KE, Yaghan RJ, Matalka II, Shatnawi NJ. Idiopathic granulomatous mastitis: time to avoid unnecessary mastectomies. Breast J. 2004;10:318-322. doi:10.1111/j.1075-122X.2004.21336.x
• 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. 2020;15(4):415-420. doi: 10.1159/000503602
• Vanovcanova L, Lehotska V, Machalekova K, et al. Idiopathic granulomatous mastitis-a new approach in diagnostics and treatment. Neoplasma. 2019;66(4):661-668. doi:10.4149/neo_ 2019_ 190201N100
• Gautier N, Lalonde L, Tran-Thanh D, El Khoury M, David J, Labelle M. Chronic granulomatous mastitis: imaging, pathology and management. Eur J Radiol. 2013;82(4):e165-e175. doi:10. 1016/j.ejrad.2012.11.010
• Lermi N, Ekin A, Ocak T, Bozkurt ZY, Ötegeçeli MA, Yağız B. What predicts the recurrence in idiopathic granulomatous mastitis?. Clin Rheumatol. 2023;42(9):2491-2500. doi:10.1007/s10067-023-06651-3
• Yildiz S, Aralasmak A, Kadioglu H, et al. Radiologic findings of idiopathic granulomatous mastitis. Med Ultrason. 2015;17:39-44. doi:10.11152/mu.2013.2066.171.rfm
• Teke M, Teke F, Alan B, et al. Differential diagnosis of idiopathic granulomatous mastitis and breast cancer using acoustic radiation force impulse imaging. J Med Ultrason. 2001;2017;44: 109-115. doi:10.1007/s10396-016-0749-2