背景:肉芽肿性乳腺炎(GM)是良性的,慢性,炎症性疾病缺乏明确的治疗指南。这个美国乳腺外科医师协会(ASBrS)前瞻性的目的,多位点注册是表征GM的表现,并确定与症状解决和最佳外观相关的治疗策略。
方法:ASBrS成员将有关患者人口统计的数据输入注册表,治疗,症状,和1年的宇宙观。最初的症状分级为轻度,中度,或严重。采用卡方检验和logistic回归分析与症状改善和美容相关的因素。
结果:总体而言,包括112名平均年龄为36岁的患者。更多的患者是西班牙裔(49.1%)和西南部(41.1%),管理包括观察(4.5%),医疗(70.5%),外科(5.4%),或联合治疗(19.6%)。83例(74.1%)患者使用了免疫抑制,包括43例接受病灶内注射类固醇的患者。与轻度或中度症状患者相比,重度症状患者更有可能接受手术干预(21.4%vs.0%和7.5%,分别为;p=0.004)。1年内,85名患者(75.9%)在中位3个月时经历了症状改善和/或消退。接受免疫抑制治疗可预测1个月时的改善或消退(比值比4.22;p=0.045)。对于20/35名患者(57.1%),为期一年的医师评估美容效果良好或良好,并且与治疗类型或症状严重程度无关。
结论:尽管转基因可以有一个长期的过程,该注册表中的大多数患者在1年内解决,具有良好的美容效果。免疫抑制治疗似乎是最有益的,基于症状的算法可能有助于指导治疗。
BACKGROUND: Granulomatous mastitis (GM) is a benign, chronic, inflammatory disease lacking clear treatment guidelines. The purpose of this American Society of Breast Surgeons (ASBrS) prospective, multisite registry was to characterize the presentation of GM and identify treatment strategies associated with symptom resolution and optimal cosmesis.
METHODS: ASBrS members entered data into a registry on patient demographics, treatment, symptoms, and cosmesis over a 1-year period. Initial symptoms were graded as mild, moderate, or severe. The Chi-square test and logistic regression were used to identify factors related to symptom improvement and cosmesis.
RESULTS: Overall, 112 patients with a mean age of 36 years were included. More patients were Hispanic (49.1%) and from the Southwest (41.1%), and management included observation (4.5%), medical (70.5%), surgical (5.4%), or combination treatment (19.6%). Immunosuppression was used in 83 patients (74.1%), including 43 patients who received intralesional steroid injections. Patients with severe symptoms were more likely to undergo surgical intervention compared with those with mild or moderate symptoms (21.4% vs. 0% and 7.5%, respectively; p = 0.004). Within 1 year, 85 patients (75.9%) experienced symptom improvement and/or resolution at a median of 3 months. Receipt of immunosuppressive therapy was predictive of improvement or resolution at 1 month (odds ratio 4.22; p = 0.045). One-year physician-assessed cosmesis was excellent or good for 20/35 patients (57.1%) and was not associated with type of treatment or symptom severity.
CONCLUSIONS: Although GM can have a protracted course, the majority of patients in this registry resolved within 1 year, with good cosmetic result. Treatment with immunosuppression appears to be most beneficial, and a symptom-based algorithm may be helpful to guide treatment.