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Non-Puerperal Mastitis in a Medellin 1 ORIGINAL PAPER Non-puerperal mastitis in a Medellin 1. Mastologist, CES University, MSc Epidemiology and Public Health (Colombia) reference center VIU, IDC Cancer Research Group, Professor UniRemington, Medellín, Mastitis no puerperal en centro de Colombia referencia en Medellín (Colombia) Research funding: None Óscar Alejandro Bonilla-Sepúlveda1 Declaration of conflict of interest: The author declares that he has no conflict of interest. DOI: https://doi.org/10.31403/rpgo.v66i2284 Received: 9 June 2020 ABSTRACT Accepted: 19 August 2020 Objective: To describe the sociodemographic data, clinical manifestations and treatment in patients diagnosed with non-puerperal mastitis. Methods: Descriptive, Online publication: 30 December 2020 retrospective study of medical records in the institutional database between January 1, 2016 and December 31, 2019. Demographic, clinical and treatment data was Correspondence: collected and analyzed using descriptive statistics. Results: The prevalence of non- Óscar Alejandro Bonilla-Sepúlveda puerperal mastitis was 3.8%, in mestizo women about 40.4 years-old at time of 3221024 opción 7 diagnosis. The most frequent reason for consultation was inflammatory changes in m [email protected] breast in 84.8% (n = 28), and presence of mass in 12.1% (n = 4). There was association with smoking in 33.3% (n = 11). 97% of the patients received initial treatment with Cite as: Bonilla-Sepúlveda OA. Non-puerperal antibiotics (n = 32), and ultrasound-guided drainage was performed in 7 cases mastitis in a referral center in Medellín (21.2%). No case had drainage by mastotomy, and one patient (9%) was treated (Colombia). Rev Peru Ginecol Obstet. 2020; with quadrantectomy-type resection. Resolution was obtained in 97% of cases (n 66 (4). DOI: https://doi.org/10.31403/rpgo. = 32) in 4.4 months average, and 7 patients (21.2%) had recurrence. Conclusion: In v66i2284 this study, non-puerperal mastitis affected women in the fourth decade of life with inflammatory changes and pain. Evolution was chronic with episodes of recurrence. Usually the disorder resolved with antibiotics and some needed ultrasound-guided drainage. Up to one third of cases was associated with smoking. Key words: Breast, Mastitis, Abscess. RESUMEN Objetivo. Describir los datos sociodemográficos, manifestaciones clínicas y tratamiento en pacientes diagnosticados con mastitis no puerperal. Métodos. Estudio descriptivo, retrospectivo de una base de registros médicos institucional, entre el 1 enero de 2016 y el 31 diciembre de 2019. Se recopilaron las variables demográficas, clínicas y de tratamiento, que fueron analizadas utilizando estadística descriptiva. Resultados. La prevalencia de mastitis no puerperal fue 3,8%. Todos los casos se presentaron en mujeres de raza mestiza, con edad media al diagnóstico de 40,4 años. El motivo de consulta más frecuente fue por cambios inflamatorios mamarios en 84,8% (n= 28), seguido por presencia de masa en 12,1% (n= 4). El 33,3% (n= 11) de casos tuvo asociación con tabaquismo. El 97% recibió antibióticos como tratamiento inicial (n= 32) y en 7 casos (21,2%) se realizó drenaje ecoguiado; ningún caso tuvo drenaje por mastotomía y en una paciente (9%) se efectuó resección tipo cuadrantectomía. Hubo resolución de la mastitis en 97% de los casos (n= 32), en 4,4 meses promedio, y 7 pacientes (21,2%) tuvieron recurrencia. Conclusiones. En este estudio, la mastitis no puerperal afectó a mujeres en la cuarta década de la vida con cambios inflamatorios y dolor. La evolución fue crónica con algunos episodios de recurrencia. Casi siempre se resolvió la mastitis con manejo antibiótico y en algunas con drenaje ecoguiado. Hasta un tercio de los casos mostró asociación con tabaquismo. Palabras clave. Mama, Mastitis, Absceso. INTRODUCTION There are many classifications of mastitis. The best known divides it into infectious (puerperal) and non-infectious (granulomatous mastitis). Ac- cording to the time of clinical presentation, it is considered acute and chronic(1). This article is aimed at mastitis not associated with lactation, a rare disorder, with a prevalence of 1 to 2%(2). Lactiferous duct ectasia plays a part in the etiopathogenesis, and is associated with periductal mastitis with dilatation of the lactiferous ducts, occurring in 5 to 9% of non-lactating women(3). Although several cases of non-puerperal mastitis and subareolar ab- scess were described in the late 1800s, it is Zuska and her colleagues who are credited with knowledge of the disease(4). In 1951, they pub- Rev Peru Ginecol Obstet. 2020;66(4) 1 Óscar Alejandro Bonilla-Sepúlveda lished clinical and pathological findings in five The study established three diagnostic criteria patients with non-puerperal mastitis complicat- necessary for non-puerperal mastitis: ed with abscess and recurrent lactiferous duct fistula. All cases were associated with subareo- • Presenting an inflammatory breast disorder lar mass and pathological telorrhea. The main or a breast abscess microscopic findings were acute and chronic inflammation of the lactiferous duct, duct dila- • No breastfeeding tion, stasis, and desquamative keratinization of the epithelium in the duct lumen. The authors • Patients with histopathology for granuloma- concluded that the disease was associated with tous mastitis were excluded. stasis of secretions within the duct, which led to dilation and inflammation or infection, abscess Descriptive analysis of sociodemographic and formation and rupture through the skin, creat- clinical variables was performed. Absolute fre- ing a fistulous tract. quencies and percentages, mean and standard deviation were calculated, according to the na- These abscesses have a chronic course, with ture and distribution of the variables. The nor- recurrent obstruction of the ducts with keratin mal distribution was validated using the Shapiro plugs and a tendency to fistula formation(5,6). Ab- Wilk test. A bivariate analysis was performed scesses, in general, are central, peri, or subareo- using the chi2 test to establish the association lar. Risk factors include smoking and diabetes(7,8). between resolution or recurrence, treatment modalities, and risk factors. For the hypothesis The objective of this retrospective study was to tests, a 95% confidence interval and a 5% signifi- review the clinical aspects, diagnosis and treat- cance level were set. Epidat software version 3.1 ment of patients with non-puerperal mastitis was used. who attended the mastology consultation at the Profamilia clinic in the city of Medellín. It is the The research was submitted to the Profamilia largest series of cases reported in Latin America. medical ethics committee, a protocol that was authorized by the medical direction. This is con- METHODS sidered a risk-free study, in accordance with the classification set forth in Article 11 of Resolution This is a retrospective descriptive study of us- No. 008430 of 1993, issued by the Ministry of ers treated in the mastology consultation at Health of Colombia, and is in line with interna- the Profamilia clinic in the city of Medellín, be- tional regulations -Helsinki declaration and ethi- tween January 1, 2016 and December 31, 2019. cal guidelines for biomedical research prepared The clinical records of 848 users treated with by the Council for International Organizations of the code IDC 10 N61X Inflammatory disorders of Medical Sciences - CIOMS-. the breast were found. 53 records with the diag- nosis of non-puerperal mastitis were identified, RESULTS and an independent database for this cohort of patients was created. 18 cases with diagnosis of Of the total of 848 patients seen in the period granulomatous mastitis were excluded and the established with diagnosis of inflammatory dis- subgroup of 33 cases with diagnosis of non-pu- orders of the breast, 53 patients with non-puer- erperal mastitis and subareolar abscess was peral mastitis were identified; 33 patients met analyzed. the inclusion criteria, with prevalence of 3.8% (Figure 1). The demographic data, clinical and pathological characteristics of the patients were obtained The 33 cases were mestizo women, 48.5% were from the clinical history, and data on ethnic Medellin residents (n = 16), with mean age 40.4 origin, age, history of smoking, clinical charac- years (SD 13.7. Range 18 to 64). The sociodemo- teristics as reason for consultation, findings on graphic characteristics are shown in Table 1. physical examination, affected side, findings on ultrasound, mammography, types of treatment The most common reason for consultation was such as antibiotic therapy or surgery, follow-up inflammatory changes, in 84.8% (n = 28), fol- and recurrence were included. lowed by associated mastalgia, in 81.8% (n = 6); 2 Rev Peru Ginecol Obstet. 2020;66(4) Non-puerperal mastitis in a Medellin (Colombia) reference center FIGURE 1. PATIENT FLOW CHART. TABLE 2. CLINICAL CHARACTERISTICS N= 848 mastology consultations (n=33) Variable Profamilia Frequency (%) 01/01/2016 to 31/12/2019 Family history of breast cancer Yes 4 (12.1) No 29 (87.9) Cigarettes smoking Yes 11 (33.3) N= 51. Met the selection criteria. No 22 (66.7) - IDC 10 Diagnosis: N61X. Reason for consultation - Inammatory disorders of the breast Mass 4 (12.1) - Non-puerperal Inflammatory changes 28 (84.8) Telorrhea 1 (3) Mastalgia Yes 6 (18.2) No 27 (81.8) N = 33. Met the inclusion criteria. Time of symptoms (months) 1. Presentad an inammatory disorder Mean 28.6 of the breast or breast abscess Standard deviation 68.4 2. Were not breastfeeding Min Max 1
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