Idiopathic Granulomatous Mastitis in India: Imaging Spectrum and Outcomes across Different Management Strategies

Idiopathic granulomatous mastitis (IGM) is a benign inflammatory breast condition that frequently mimics carcinoma, posing significant diagnostic and therapeutic challenges. In tuberculosis-endemic regions, differentiation from tuberculous granulomatous mastitis (TGM) is particularly critical. This dual-centre retrospective study from North India evaluates the clinical, radiological, and pathological profiles of granulomatous mastitis and compares outcomes across different management strategies.

We retrospectively reviewed 67 consecutive patients with histopathologically confirmed granulomatous mastitis treated between 2022 and 2024. Diagnosis was established using core needle biopsy, followed by a standardized evaluation to exclude tuberculosis. Patients were managed with observation with aspiration, corticosteroid therapy (systemic or intralesional), or surgical intervention based on disease severity and treatment response.

Of the 67 patients, 58 (86.5%) were diagnosed with IGM and 9 (13.4%) with TGM. Observation with aspiration was the most common initial approach for IGM (n = 37, 63.7%). Although 35.1% experienced recurrence by 6 months, all achieved complete remission by 18 months without treatment escalation. Systemic corticosteroid therapy (n = 3) was associated with recurrence in all cases, whereas intralesional steroid injections (n = 3) resulted in sustained remission without recurrence. Surgical intervention was reserved for 13 patients with refractory disease and yielded favourable long-term outcomes.

Accurate distinction between IGM and tuberculosis is essential in endemic settings. Our findings support a step-wise approach to IGM with a long-term follow-up to address the high rate of recurrence in these patients.