Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis: A Systematic Review

Table 1

Characteristics of studies included and outcome measure.

	Ref	Country	N	Mean age	Rec	f/u (m)	Conclusions	Study type	Study quality
1	Al Nazer, 2003 [16]	Saudi Arabia	11	35	3	—	Granulomatous mastitis is not unheard of and clinicians should keep it in their list of differential diagnosis of breast lumps	Case series	8
2	Bani-Hani et al., 2004 [17]	Jordan	24	34.3	4	31.2	A greater awareness of the rare entity of idiopathic granulomatous mastitis is mandatory to avoid unnecessary mastectomies	Cohort	7
3	Eric et al., 2004 [18]	China	9	45.7	4	18.7	It is important to differentiate IGM from carcinoma of the breast. Tissue biopsy remains the gold standard to confirm the diagnosis	Case series	7
4	Baslaim et al., 2007 [19]	Saudi Arabia	20	34	0	24	Management of IGM cases needs to be tailored according to the clinical presentation	Cohort	6
5	Uriel Katz et al., 2007 [20]	Israel	4	36.25	1	22	Clinicians should consider the possibility of idiopathic granulomatous mastitis in young women with inflammatory breast processes and negative findings on relevant biopsy, laboratory, and imaging studies	Case series	8
6	Al-Khaffaf et al., 2008 [21]	Saudi Arabia	18	36	3	—	IGM patients are younger, have given birth more recently, and are less likely to be Caucasian as compared with PDM patients	Cohort	8
7	Goldman et al. 2009 [22]	USA	7	32	—	—	When an idiopathic condition such as IGM is identified, a thorough clinical history and evaluation should be conducted to exclude known causes of granulomas	Case control	6
8	Nemenqani et al. 2009 [23]	Saudi Arabia	7	38	—	—	The definitive diagnosis can be established by a combination of the cytomorphologic features and microbiologic studies	Cohort	6
9	Kok and Telisinghe, 2010 [24]	Brunei	43	34	10	15	Complete surgical excision or incision and drainage of the lesion are the main treatment modalities	Cohort	7
10	Sakuraiet al., 2011 [25]	Japan	8	44.8	1	12	Steroid therapy was effective for the treatment of IGM	Cohort	6
11	Akbulut et al., 2011 [26]	Turkey	4	33.25	0	5.25	MTX in the present cases of IGM was effective, prevented complications, and limited corticosteroid side effects	Case series	7
12	Lacambra et al., 2011 [27]	China	33	37.85	0	—	Histologically, IGM is associated with more plasma cells	Cohort	6
13	Boufettal et al., 2012 [28]	Morocco	20	38.1	4	—	IGM is a rare entity. The treatment is medical alongside surgical excision	Cohort	6
14	Hugon-Rodin et al., 2012 [29]	France	14	33	13	61.5	Medical treatment with steroid reduces the duration and number of episodes. It also prevents the need for invasive breast surgery	Case series	8
15	Altintoprak et al., 2013 [13]	Turkey	26	37.5	4	38.4	This study was not able to support the eventual existence of an autoimmune basis of IGM.	Cohort	6
16	Neel et al., 2013 [30]	France	23	39	18	95.8	The value of immunomodulatory drugs such as colchicine or hydroxychloroquine deserves further investigation	Cohort	7
17	Omranipour et al., 2013 [31]	Iran	43	33.5	7	16	We hypothesized that a shorter lactation period may cause more milk stasis and extravasation and be contributory to IGLM	Cohort	6
18	Oran et al., 2013 [32]	Turkey	46	33	8	35.4	Treatment can be designated according to the extent and the severity of the disease	Cohort	7
19	Akahane et al., 2013 [33]	Japan	12	36	2	22	These results suggest that steroid treatment may be the first choice in treatment strategies for GLM	Cohort	6
20	Hur et al., 2013 [34]	South Korea	50	37.1	3	32	Surgery may play an important role when a lesion is determined to be mass forming or appears localized as an abscess pocket during breast examination or imaging study	Cohort	6
21	Cornejo-Juárez et al., 2014 [35]	Mexico	58	38	0	16.7	Biopsy is the gold standard for its diagnosis and should be taken in any patient even with a mild suspicion of cancer	Cohort	7
22	Kiyak et al., 2014 [36]	Turkey	24	38.4	1	38.4	Histopathologic confirmation is mandatory to ensure that a malignancy is not missed	Cohort	6
23	Salehi et al., 2014 [37]	Iran	59	32.48	34	12	This clinical trial demonstrated that pharmaceutical treatment has appropriate efficacy, in treatment and prevention of IGM relapse	RCT	3
24	Pandey et al., 2014 [38]	USA	49	35	9	9	Treatment with steroids is an effective breast-conserving option	Cohort	7
25	Mahlab-Guri et al., 2015 [39]	Israel	17	44.6	—	56.4	The recommended treatment modalities are observation alone or corticosteroids; surgery should be avoided	Cohort	8
26	Sheybani et al., 2015 [7]	Iran	22	32.82	3	11.91	Corticosteroids and MTX, with or without surgery, are the treatment of choice in these patients	Cohort	7
27	Atak et al., 2015 [40]	Turkey	40	39.07	14	24.85	Surgical excision still seems to be the best treatment method for IGM patients	Cohort	5
28	Bouton et al., 2015 [41]	USA	37	33	3	7.4	IGM is a self-limited benign condition that will resolve spontaneously without treatment	Cohort	6
29	Gopalakrishnan et al., 2015 [42]	India	38	32.85	1	24	The combination of limited surgical treatment and systemic prednisolone given for 6 months effectively controls the disease as well as prevents recurrence	Cohort	5
30	Mizrakl et al.i, 2015 [43]	Turkey	49	34.3	—	—	Systemic therapy with corticosteroids is an effective and appropriate treatment option for IGM. It can provide complete disease resolution and prevent recurrence	Cohort	6
31	Skandarajah and Marley, 2015 [44]	Australia	17	40	5	6	Exclusion of underlying systemic autoimmune conditions and judicious use of steroids and steroid-sparing agents such as methotrexate	Cohort	8
32	Yabanoğlu et al., 2015 [45]	Turkey	77	36.8	9	8.7	A wide surgical excision is the preferred approach for treating patients with IGM because of the low recurrence rate	Cohort	5
33	Aghajanzade et al., 2015 [14]	Iran	206	32	11	9–18	Corticosteroids are the first line of treatment with a good therapeutic response	Cohort	6
34	Ahmed and Maksoud, 2016 [46]	Egypt	13	35.53	2	24	Using therapeutic mammoplasty techniques in surgical management of IGM in moderate to large breasts seems justifiable with good results regarding recurrence and postoperative patients’ satisfaction	Cohort	5
35	Elzahaby et al., 2016 [47]	Egypt	30	33	1	19	History of breast feeding together with early failure of complete nursing from a single breast is the most important risk factors for development of IGM in young women	Cohort	5
36	Helal et al., 2016 [48]	Egypt	65	38	5	—	This study supports the few recent studies that have detected GPB in IGM with cystic vacuoles	Cohort	4
37	Velidedeoglu et al., 2016 [9]	Turkey	10	38.4	1	21	Surgical management should be avoided unless all medical treatment options have been exhausted	Cohort	6
38	Calis and Karabeyoglu, 2017 [49]	Turkey	19	44	3	11	Patients who followed up by observation should be explained that IGM is a chronic disease and that it may recur in certain periods	Cohort	6
39	Farouk et al., 2017 [50]	Egypt	30	31.6	0	15.5	Rifampicin is effective in the treatment of patients with IGLM	Cohort	7
40	Freeman et al., 2017 [51]	USA	14	31.7	—	3	Granulomatous mastitis is uncommon and difficult to diagnose and manage. We review our experience, the literature, and propose an algorithm for diagnosis and management	Cohort	5
41	Shin et al., 2017 [52]	South Korea	34	35	6	37.6	Wide excision resulted high recurrence than steroid and drainage groups and left extensive scarring	Cohort	7
42	Co et al, 2018 [53]	Hong Kong	102	33	12	14	IGM is uncommon with a recurrence rate of 12%, especially in patients with history of smoking and isolation of C. kroppenstedtii	Cohort	7
43	E. Uysal et al., 2018 [15]	Turkey	720	36	122	16	Our findings show that history of pregnancy, breastfeeding, breast infection, and smoking were the risk factors for IGM recurrence	Cohort	7
44	Cetin et al., 2019 [54]	Turkey	124	33.9	17	21.9	Topical steroids would be among first-line treatment options of IGM	RCT	4
45	Chen et al., 2019 [55]	China	32	32	3	15.6	Ductal lavage for patients with NLM is feasible and safe, and a definitive randomized controlled trial for further investigation is warranted	RCT	3
46	Davis et al., 2019 [56]	USA	120	35	19	20	Idiopathic granulomatous mastitis is a self-limited, benign condition that waxes and wanes and eventually resolves without resection	Cohort	8
47	Kaviani et al., 2019 [57]	Iran	374	34.6	—	—	The outcome of prednisolone use in severe cases was comparable to NSAIDs	Cohort	8
48	Li, 2019 [58]	China	75	35.9	3	6	Surgery and symptomatic treatment can completely remove the lesions inorder to cure the disease	Cohort	7
49	Yaghan et al., 2019 [59]	Jordan	68	37.75	19	10	Treatment of IGM in any institution should be the responsibility of a multidisciplinary team	Cohort	6
50	Azizi et al., 2020 [6]	Iran	474	33.9	118	—	The recurrence rate was 24.8%, and breast skin lesions were associated with a significantly higher odds of recurrence	Cohort	6
51	Haddad et al., 2020 [60]	Iran	17	36.68	3	16.4	For those patients with IGM who are not candidates for surgical intervention or require corticosteroid‐sparing medical treatment as well as those whose symptoms recur after tapering of their initial treatment, MTX‐based treatment could be an attractive alternative therapeutic option with favorable outcome and less frequent side effects	Cohort	6
52	Kehribar et al., 2020 [61]	Turkey	33	36.9	0	24	Steroid + methotrexate treatment is an effective and reliable method for ensuring long-term remission in patients with idiopathic granulomatous mastitis diagnosis	Cohort	6
53	Montazer et al., 2020 [62]	Iran	30	34.8	3	12	High dose prednisolone has a high success rate and a lower recurrence in the treatment of IGM and could reduce the need for surgery	RCT	4
54	Postolova et al., 2020 [63]	USA	19	33.5	3	36	MTX monotherapy is an effective treatment for IGM	Cohort	7
55	Steuer et al., 2020 [64]	USA	32	35.6	—	12	Adequate medical management may alleviate the need for surgical intervention	Case series	9
56	Tekgöz et al., 2020 [65]	Turkey	53	37.2	5	13.83	Methotrexate seems to be efficient in the treatment of idiopathic granulomatous mastitis and provides drug-free remission	Cohort	7
57	Zhang et al., 2020 [66]	China	53	34.6	4	12.6	Surgical management combined with postoperative oral Yanghe decoction treatment yielded a higher CR rate and lower recurrence rate than surgery alone	Cohort	6
58	Emsen et al., 2021 [67]	Turkey	51	37	—	—	The observed changes in T cells, NK, and NKT cells suggest that there is systemic immune dysregulation in patients with IGM	Case control	7
59	Koksal, 2021 [68]	Turkey	134	33.5	10	—	Clinical differences were detected among the patients with IGM, and classification of patients by severity is needed to plan the optimal treatment approach	Cohort	5
60	Ringsted and Friedman, 2021 [69]	Portland	28	32	7	27	MTX is a promising treatment for IGM	Case series	9
61	Shojaee et al., 2021 [70]	Iran	87	34.11	25	26	The use of minimally invasive methods such as drainage plus low-dose steroids is a more effective method with fewer side effects than the other two methods	Cohort	5
62	Tang et al., 2021 [71]	Singapore	77	36	—	18	Smoking is associated with higher number of flares of IGM and should be discouraged in IGM patients	Cohort	7
63	Velidedeoğlu et al., 2021 [72]	Turkey	86	31.85	11	29.65	All physicians should not neglect questioning breast complaints in patients with EN since EN may be caused by IGM	Case control	8
64	Koksal, 2022 [73]	Turkey	61	36	—	—	Classification of patients by severity is needed to plan the optimal treatment approach	Cohort	6
65	Li et al., 2021 [74]	China	15	30.5	—	—	Observational therapy during pregnancy for PAGM is reliable and feasible	Case series	6
66	Dalbaşı and Akgül, 2021 [75]	Turkey	62	36.5	7	24	Methotrexate + low-dose steroid therapy is successful in the treatment of IGM	Cohort	6
67	Karami et al., 2021 [76]	Iran	118	34	12	10	Local betamethasone LA injection in breast-limited IGM is as successful as current standard treatment and shortens the complete healing time compared to treatment with systemic therapy	RCT	4
68	Bayrak et al., 2021 [77]	Turkey	77	39.24	28	24	A detailed assessment accompanied with clinical, radiological, and pathological findings should be performed to achieve an accurate diagnosis and effective patient management in IGM	Cohort	6
69	Pala et al., 2022 [78]	Turkey	114	35.8	15	—	For optimal management and timing the appropriate therapy, the ideal biopsy procedure, special stains, and a multidisciplinary team consisting of the surgeon, pathologist, and radiologist are the most important issues	Cohort	5
70	Soltany et al., 2022 [79]	Syria	17	37.2	4	—	The histopathological study is considered as the most crucial element in the multidisciplinary approach to diagnose idiopathic granulomatous mastitis (IGM) and determine the optimal management to be administered	Cohort	5
71	Velidedeoğlu et al., 2022 [80]	Turkey	152	—	51	—	IGM is typically seen in women of childbearing age with a recent history of pregnancy and lactation	Cohort	5

Ref: reference, Rec: recurrence, f/u: follow-up. Newcastle–Ottawa, JBI risk of bias, and Jadad checklists were used for the quality assessment of cohort/case-control, case series, and randomized controlled trial (RCT) studies.