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

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.