Effect of radiological response on recurrence treating granulomatous mastitis with steroids


Çetin K.

Uluslararası Katılımlı 3. Ulusal Meme Cerrahisi Kongresi, 28 - 30 May 2021, pp.30

  • Publication Type: Conference Paper / Summary Text
  • Page Numbers: pp.30

Abstract

Introduction: IGM is a rare, chronic, frequently recurring, benign breast disease affecting women of reproductive age. Even though complete clinical response can be achieved by steroid therapies recurrence rates are high. There is no consensus on dosage, duration, application form or termination criteria for steroid therapy. Complete clinical response is accepted as termination criteria for steroid therapy. To our knowledge there is no suggestion in the literature as to evaluate radiological response to terminate steroid therapy.

Aim: Aim of this study is to investigate factors affecting recurrence in treatment of IGM with steroids and finding the answer to the question ‘‘should decision of terminating the treatment be based on clinical response solely or should radiological response be taken into account too’’

Methods: This retrospective cohort study is conducted with patients treated with steroid therapies, obtained complete clinical response, has imaging studies(USG±MRI) at the time of termination of therapy and with a follow up of at least 30 months. Patients demographical data, presentation and extent of disease, previous therapies and their relation with radiological response and all these parameters relation with recurrence has been investigated.

Results: Complete clinical response is obtained with steroid treatment protocols (topical, oral or combined steroid therapy) in 89 patients in the cohort. When the treatment was terminated 38 (%42,7) patients had partial radiological response (RPP), 51 (%57,3) patiens had complete radiological response (CRR). During mean follow-up of 42 ± 10.3 months, 22 (%27,4) patients had recurrence. Mean age of patients who had recurrence was higher than patients did not (35,8 ± 6,8 vs 32,4 ± 6, p= 0,03) and majority of the recurrences were seen in group PRR [Group PRR; n: 19 (%86,4) vs Group CRR; n:3 (%13,6), (p<0.001)]. Recurrence rate was %5,9 in group CRR and %50 in group PRR. Furthermore presence of abscesses and extent of disease in the breast was not associated with recurrence but was found to be related with partial radiological response (p=0,02 and p= 0,03 respectively).

Conclusion: In the treatment of IGM with steroids, to terminate the therapy radiological response should be assessed along with clinical response. Continuing the steroid therapies until obtaining CRR or removing the only radiologicaly detectable rest disease by surgery, not impairing breasts integrity, can reduce recurrence rate.

Keywords: Granulomatous mastitis, steroid, recurrence, MRI, Radiological response