Image-guided and surgical management of breast infections: Addressing diagnostic and therapeutic challenges

Inflammatory breast conditions encompass a broad spectrum, ranging from common acute lactational mastitis to rare chronic granulomatous diseases such as idiopathic granulomatous mastitis (IGM) and tuberculous mastitis (TBM). Chronic forms often mimic breast cancer, both clinically and radiologically, posing significant diagnostic and therapeutic challenges. The objective was to review the latest evidence on the epidemiology, pathogenesis, imaging findings, microbiology, and management of breast infections, with a focus on differentiating chronic granulomatous mastitis from malignancy and the role of minimally invasive interventions.

We searched PubMed, Embase, and Scopus for English-language studies published between January 2005 and October 2023 using keywords such as "mastitis," "breast abscess," "granulomatous mastitis," "tuberculous mastitis," "breast imaging," and "management." Original studies, reviews, and case series were included. Key information was extracted and summarized.

Lactational mastitis and breast abscesses are common and usually respond well to antibiotics or ultrasound-guided drainage. Non-lactational abscesses, IGM, and TBM are less common but often resemble malignancy. Ultrasound is the primary imaging tool, with mammography and MRI used selectively to define the extent of disease or to rule out malignancy. Minimally invasive drainage techniques are effective, providing high cure rates with superior cosmetic outcomes.

Accurate diagnosis of breast infections requires integrated clinical, radiologic, microbiologic, and histologic assessment. Diagnosing chronic granulomatous mastitis can be challenging, especially in areas where tuberculosis is widespread. Wider use of image-guided drainage and a multidisciplinary approach can maximize results while lowering morbidity.