Idiopathic Granulomatous Mastitis: From Diagnosis to Treatment - A Contemporary Evidence-Based Review and Proposed Clinical Management Algorithm

Dr. Sandip Kumar

Abstract: Background: Idiopathic granulomatous mastitis (IGM) is a benign but chronic inflammatory breast disorder that can closely mimic infection and inflammatory breast carcinoma. Although the number of publications has increased substantially, treatment remains heterogeneous and high-quality comparative evidence is limited. Objective: To synthesize contemporary evidence on the diagnosis, classification and treatment of IGM and to propose a practical, severity-based clinical management algorithm for surgical and breast-care practice. Methods: A contemporary narrative evidence review was undertaken using targeted searches of PubMed, PubMed Central and publisher databases through August 2026. Priority was given to systematic reviews, meta-analyses, randomized trials, multicentre cohorts, diagnostic studies and consensus statements. Evidence was synthesized qualitatively; no new meta-analysis was performed. Results: Core-needle biopsy is strongly supported for diagnosis, with exclusion of infectious and systemic granulomatous disease before the label 'idiopathic' is applied. Ultrasound is the principal imaging tool, while mammography and MRI are used selectively. The 2024 Turkish consensus introduced a practical clinical classification, and a 2025 treatment consensus linked severity to treatment intensity. A 2024 multicentre randomized non-inferiority trial found ductal lavage followed by observation non-inferior to oral corticosteroids for 1-year complete clinical response. A 2024 systematic review of intralesional corticosteroids reported high response rates, although comparative evidence remains limited. A 2026 multicentre cohort evaluated a Pittsburgh clinical/ultrasound classification and found markedly better response when treatment was concordant with its algorithm. Conversely, a 2026 scoping review found that most primary studies remain level 3?4 evidence and only three randomized trials were identified. Conclusion: Contemporary IGM management should be individualized according to clinical and imaging severity rather than defaulting to surgery or systemic corticosteroids. Mild localized disease may be observed; localized disease may be considered for intralesional/topical corticosteroids; systemic corticosteroids are reasonable for extensive inflammatory disease; methotrexate is a useful steroid-sparing option for selected resistant/recurrent cases; and surgery should be reserved for selected persistent, complicated or refractory disease. A standardized diagnostic framework and prospective validation of severity-based algorithms are the major priorities for future research.

Keywords: Idiopathic granulomatous mastitis, granulomatous mastitis, breast inflammation, core-needle biopsy, intralesional corticosteroid, systemic corticosteroid, methotrexate, surgery, ductal lavage, treatment algorithm

How to Cite?: Dr. Sandip Kumar, "Idiopathic Granulomatous Mastitis: From Diagnosis to Treatment - A Contemporary Evidence-Based Review and Proposed Clinical Management Algorithm", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 1091-1099, https://www.ijsr.net/getabstract.php?paperid=MR26816112041, DOI: https://dx.doi.org/10.21275/MR26816112041

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