Estudo comparativo da mastite granulomatosa idiopática e mastite por tuberculose: achados clínicos, métodos de investigação diagnóstica e desfechos terapêuticos

Abstract

Granulomatous mastitis (GM) is an inflammatory condition chronic and difficult to diagnose, usually affecting women in the menacme and simulating malignant neoplasm, both in its clin-ical characteristics and in mammography and ultrasound. It can present multiple recurrences, despite the use of several drugs, causing breast deformities and influencing the quality of life. It´s classified in specific and non-specific (idiopathic) form. Among the specific causes of MG are tuberculosis, sarcoidosis, autoimmune diseases, and hyperprolactinemia. The idiopathic form is a diagnosis of exclusion. To identify the etiology of the disease and evaluate the clinical characteristics, diagnostic tests and therapeutic outcomes, mainly in mammary tuberculosis (MT) and idiopathic granulomatous mastitis (IGM). This is a retrospective study was carried out to evaluate the medical records of 76 women diagnosed with GM (55 MT and 21 IGM) between 2007 and 2017, based on clinical findings and laboratory tests (identifica-tion of bacillus by Ziehl Neelsen staining, culture and PCR). The associations of the final di-agnosis (MT and IGM) with the clinical-epidemiological, radiological, laboratory, histopatho-logical and therapeutic characteristics analyzed by the chi-square test, Fisher's Exact and Stu-dent's t-test. Kappa used to evaluate the agreement between the initial presumptive diagnosis for MT and MGI and those who actually had MT and IGM. A positive association (statistical significance) observed for the differential diagnosis of MT and IGM only in neutrophil changes in hemogram, transaminases and the presence of multinucleated giant cells of Lang-hans type in histology. The culture sensitivity for tuberculosis bacillus isolation was 10%; the Ziehl Neelsen (ZN) staining in the mammary aspirate was 7.1% and 3.3% in the ZN of the histological examination. The diagnosis based only on the presumption, without evidence of the bacillus in microbiological examinations, showed a concordance of 98.1% with a Kappa coefficient equal to 0.95. The MT and IGM diagnosis, based only on the presumption, consi-dered optimal and reliable by the concordance test. The sensitivity of the microbiological di-agnostic methods was low, which agrees with the literature data; however, they are important to help define the etiology of the disease and reduce the probability of therapeutic failure with unfavorable outcomes. There is no common sense about the investigation and treatment of MG, however new diagnostic and therapeutic approaches are important for the management of this disease, given the overlap of clinical, laboratory and histological findings.