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Bilateral granulomatous mastitis associated with ductoscopy.

Ranxi Shu1, Ting Pan1, Kehan Yao1

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Summary

Ductoscopy, a procedure for nipple discharge, may trigger granulomatous mastitis (GLM) in some patients. Detection of neutrophils and lymphocytes in ductal fluid is an independent risk factor for GLM development post-procedure.

Keywords:
Bilateral granulomatous mastitis (bilateral GLM)erythema nodosum (EN)mammary duct injurymammary ductoscopyneutrophils and lymphocytes

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Area of Science:

  • Breast pathology
  • Surgical procedures
  • Inflammatory diseases

Background:

  • Granulomatous mastitis (GLM) can present with nipple discharge from the unaffected breast.
  • Ductoscopy, used for evaluating discharge, has been anecdotally linked to new GLM cases.
  • The relationship between ductoscopy and subsequent GLM requires investigation.

Purpose of the Study:

  • To investigate the potential association between ductoscopy and the development of granulomatous mastitis.
  • To identify risk factors for GLM formation following ductoscopy in patients with nipple discharge.

Main Methods:

  • Retrospective analysis of 40 GLM patients undergoing ductoscopy on the contralateral healthy breast.
  • Division into bilateral (10) and unilateral (30) GLM groups.
  • Logistic regression analysis to identify risk factors for post-ductoscopy GLM.

Main Results:

  • Neutrophils and lymphocytes in ductal cytology smears were identified as an independent risk factor (P=0.02) for mass occurrence post-ductoscopy.
  • High predictive value (AUC=0.843) for erythema in lower limbs following contralateral breast mass after ductoscopy, with good sensitivity and specificity.

Conclusions:

  • Ductal injury during ductoscopy may lead to inflammation and granulomatous reactions, potentially initiating GLM.
  • The procedure might mimic the pathogenesis of GLM in cases involving mammary duct injury.
  • Findings suggest ductoscopy could be a trigger for GLM in susceptible individuals.