The Role of Imaging Methods in the Diagnosis and Treatment of Idiopathic Granulomatous Mastitis

Idiopathic granulomatous mastitis (IGM) is an uncommon chronic inflammatory disease of the breast with an unclear etiology that mostly impacts young women. Its incidence is higher in the Middle East and Asian countries, particularly in Türkiye. Clinical signs such as mass, fistula formation, swelling, and radiographic abnormalities such as lymph node enlargement, abscess, calcifications, localized or widespread asymmetric density, and hypoechoic lesions may result in a misdiagnosis of malignancy or infection. There are no imaging findings that distinguish between IGM and breast cancer in any imaging method; in most cases, imaging tests like ultrasonography, magnetic resonance imaging, or mammography reveal non-specific characteristics, leading to biopsy. Histological assessment is used to reach a conclusive diagnosis of IGM. Common medical treatments include systemic steroid treatment (oral corticosteroid), local steroid treatment (local steroid injection in breast,), antibiotics, immunosuppressive drugs (methotrexate, etc.), and monoclonal antibodies. Abscess drainage and surgical excision are further alternatives. Although the conclusive diagnosis of IGM is made histologically, imaging methods have a significant impact in evaluating the number, location, their size, abscess development, and the likelihood of intervention, stability or change in lesions, and response to treatment in patients with confirmed diagnosis. In addition, radiology and interventional radiology units guide clinicians in the timely diagnosis of the disease and play an important role in local steroid injection, which is used effectively in its treatment.