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    Diagnosis, Approach, and Clinical Classification of Idiopathic Granulomatous Mastitis: Consensus Report
    (Karger, 2024) Emiroğlu, Mustafa; Akcan, Alper; Velidedeoğlu, Mehmet; Girgin, Sadullah; Aytaç, Özgür; Cantürk, N. Zafer; Yılmaz, Kerim Bora; Çetin, Kenan
    Objective: The aim of the idiopathic granulomatous mastitis (IGM) consensus study was to evaluate the etiology, diagnostic steps, and differential diagnosis and propose a widely accepted clinical classification of this mysterious breast disease. Method: The organization of a national IGM consensus was decided by the joint evaluation of the Turkish Federation of Breast Diseases Societies, SENATURK, and the Society of Breast Surgery. First, a working group of 11 members was formed, and a survey and workshop were organized to reach a common consensus. The modified Delphi method was used in the consensus methodology. Voting rates of 80% and above were considered as acceptance. Results: The consensus was 45/50 (92%) that core needle biopsies are necessary for the diagnosis of IGM and 39/40 (97%) that a new clinical classification is needed. The proposed Turkish clinical classification of IGM was accepted by 94% in three rounds of voting. Conclusion: This disease should be considered etiologically idiopathic. Tissue diagnosis and pathological evaluation are recommended for treatment. The proposed IGM Turkey classification was strongly accepted. Idiopathic granulomatous mastitis is a highly heterogeneous group of diseases. There is ongoing controversy regarding the etiology, clinical classification, and treatment algorithm of the disease. There is no common terminological language for the clinical signs and symptoms of the disease. Treatment algorithms are diverse, and there is no standardization. Scientific comparisons cannot be made precisely due to the inclusion of heterogeneous groups in studies. Since there is no consensus on the severity of the disease, the types of treatment do not allow for comparisons between groups with the same clinical severity. These scientific limitations create difficulties in establishing national/international treatment algorithms or the acceptance of proposed algorithms. This consensus, prepared by our working group, defines a diagnostic algorithm for disease diagnosis and a terminological classification. The classification system, prepared according to disease severity, will be a pioneer in comparing patient groups and developing treatment algorithms.
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    Öğe
    Idiopathic Granulomatous Mastitis: A Consensus Report on Treatment and Follow-Up Approaches Based on the Turkish Clinical Classification
    (Karger, 2025) Emiroğlu, Mustafa; Çetin, Kenan; Yılmaz, Kerim Bora; Velidedeoğlu, Mehmet; Girgin, Sadullah; Akcan, Alper; Aytaç, Özgür
    Objective: The second consensus study on idiopathic granulomatous mastitis (IGM) aimed to establish treatment options based on the clinical classification proposed in the first consensus, standardize criteria for treatment discontinuation, and develop follow-up protocols. Method: A structured methodology, identical to the first consensus study, was employed. An 11-member working group of breast surgeons experienced in IGM from various clinics across the country was formed. The modified Delphi method was used, with a consensus threshold of 80% agreement. Results: Three voting rounds were conducted to develop the IGM treatment algorithm. In Round 1, observation was established as the first-line option for Type 1 disease (81%) and pregnancy/lactation cases (85%). Round 2 achieved consensus on systemic steroids (SS) as the first-line treatment for Type 3 cases (84%), combination therapies for resistant cases (82%), and reclassification of recurrent cases to guide treatment planning (94%). In Round 3, consensus was reached on the use of immunosuppressive therapy (IMT) for cases where steroids are contraindicated in Type 3 (81%), the use of IMT for resistant cases (93%), avoiding surgery as the first-line option for Type 1 cases (81%), and requiring complete clinical and radiological response before discontinuing treatment (81%). However, no consensus was reached on the first-line treatment for Type 2 disease. Conclusion: This consensus study successfully developed a treatment algorithm for IGM, prioritizing observation for Type 1 disease and cases involving pregnancy or lactation, and recommending systemic steroids (SS) and immunosuppressive therapies for Type 3 cases. The findings underscore the critical importance of achieving complete clinical and radiological remission before discontinuing treatment. However, the lack of consensus on the treatment of Type 2 disease highlights the need for further research into this challenging subtype.