Mammary Tuberculosis With Various BMI And Menstrual Consequences In Egyptian Women: Enhancing A Novel Diagnostic And Treatment Strategy Avoiding Surgery

Abstract

Background/aim: Tuberculosis (TB) is a rare but important disease if it affects the female breast. The association between mammary gland (non-genital extra-pulmonary) TB and health problems has been largely neglected. The association between body mass index (BMI) and TB risk is under research, as well as menstrual irregularities.  Recent literature doesn’t provide clear guidelines for mammary TB management. This study aimed to; highlight the role of radiological diagnostic modalities, find the association between mammary TB & BMI and its effect on menstrual patterns, and assess the new protocol of medical treatment strategy and the requirement of surgery.

Material and methods: This is a cross-section prospective study comprising 3400 female patients who had breast lesions and were referred by a gynecologist after detailed medical history (menstrual patterns) and clinical examination. Then diagnostic breast imaging was done using digital mammography, and breast ultrasonography, the patients were classified into four groups according to body mass index (BMI); under-weight patients (no. 48), a normal-weight patients (no. 658), overweight patients (n = 1243) and obese patients (no. 1451). Dedicated investigations were done for those who had suspected inflammatory TB breast lesions (28 patients); transvaginal ultrasonography, laboratory serum hormonal tests (FSH, LH, and Prolactin), fine needle aspiration cytology (FNAC), tuberculosis workup, then those patients referred to a surgeon for management.

Results: The data of this study revealed, the mean age of  Egyptian female patients was 34 ± 2 years, there were 3372 female patients who had localized breast lesions (1035 fibrocystic breast changes, 948 benign lesions and 1389 malignant lesions) diagnosed by digital mammography and ultrasonography. Out of those patients, the 28 female patients diagnosed with inflammatory breast lesions (TB), presented with different menstrual patterns. The overweight and obese female patients had low association with mammary TB compared to under and normal-weight patients, while those patients with high BMI had significant association with malignant breast lesions. Among under-weight 28 patients, non-genital mammary TB was diagnosed, associated with reversible menstrual irregularities in 75% of patients. The serum levels of FSH and LH were significantly higher in those patients. These patients received two phases of anti-tuberculous therapy (ATT) for six months and the treatment outcome was followed-up. There were no relapsing or recurrent cases were detected.

Conclusion: Tuberculous mastitis (TM) as an odd face of tuberculosis, should be considered in women having breast inflammatory criteria with low BMI and different menstrual patterns. BMI had a negative association with TB risk (paradox). The effect on the menstrual cycle is reversible.  Medical treatment by ATT for six months is satisfactory without surgery with good prognosis.