Different Treatments for Granulomatous Lobular Mastitis: A Systematic Review and Meta-Analysis

Abstract

Objective: Granulomatous lobular mastitis (GLM) is infrequently diagnosed. This study aimed to evaluate the efficacy and safety of managements for GLM in the nonlactation period.

Methods: Publications were retrieved from PubMed, EMBASE, and the Cochrane library on September 10, 2018. We pooled and compared the outcome parameters and complete remission (CR) rates between different treatments using a meta-analysis.

Results: Twenty-one publications including 970 patients treated with surgical excision, steroids, abscess drainage, antibiotics, and observation were included. Surgery significantly improved CR rate compared with steroids (p = 0.0003). There was no difference in the CR rate in patients treated with surgery alone or combined with steroids (p = 0.28). Surgery showed borderline significant efficacy in the CR rate compared with antibiotics (p = 0.06) and abscess drainage (p = 0.06). No difference was observed in effectiveness between observation and surgical management in patients diagnosed with early GLM and mild symptoms.

Conclusions: Although surgery was the ideal management for GLM, steroids and antibiotics might be ideal managements for GLM patients who are worried about surgical scars. Observation was an impressive alternative for patients with early GLM.

Keywords: Granulomatous lobular mastitis; Meta-analysis; Steroids; Surgical excision.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Copyright © 2019 by S. Karger AG, Basel.

Figures

Fig. 1

Adapted PRISMA flow diagram. GLM, granulomatous lobular mastitis; GM, granulomatous mastitis.

Fig. 2

Forest plot for the clinical effectiveness of surgical management for GLM patients. A Pooled analysis of 10 studies including surgery and steroid treatment. B Pooled analysis of 4 studies covering patients diagnosed with early GLM and treated with close observation or surgical excision. C Pooled analysis of 3 studies including comparative outcomes of GLM patients treated with surgery and surgery plus steroids. D Pooled analysis of 3 studies including GLM patients treated with steroids and steroids plus surgery. GLM, granulomatous lobular mastitis; M-H, Mantel-Haenszel.

Fig. 3

Forest plot for the clinical effectiveness of surgical management for GLM patients compared with antibiotics (A) and abscess drainage (B). GLM, granulomatous lobular mastitis; M-H, Mantel-Haenszel.

Fig. 4

Forest plot for the clinical effectiveness of steroids management for GLM patients. A Pooled analysis of 5 studies including GLM patients treated with steroids and antibiotics. B Pooled analysis of 4 studies covering patients diagnosed with early GLM and treated with steroids or close observation. C Pooled analysis of 2 studies including comparative outcomes of GLM patients treated with steroids and abscess drainage. D Pooled analysis of 2 studies including GLM patients treated with steroids and prednisone plus methotrexate. GLM, granulomatous lobular mastitis; M-H, Mantel-Haenszel.

Fig. 5

Forest plot for the effectiveness of observation for GLM patients. A Pooled analysis of 5 studies including GLM patients treated with observation and abscess drainage. B Pooled analysis of 2 studies covering patients diagnosed with GLM and treated with antibiotics or close observation. GLM, granulomatous lobular mastitis; M-H, Mantel-Haenszel.