Establishing a dedicated granulomatousmastitis service: bringing clarity to chronic breast inflammation
This article describes the development of a dedicated granulomatous mastitis service at King’s College Hospital NHS Foundation Trust to improve care for patients with chronic non-puerperal mastitis, including idiopathic granulomatous mastitis. It highlights how patients with persistent breast inflammation often experience prolonged diagnostic journeys, recurrent abscesses, repeated interventions and uncertainty about the cause of their symptoms. Traditional pathways can struggle because infectious, anaerobic, Corynebacterium-associated and idiopathic inflammatory disease may present with overlapping clinical, imaging and histological features.
The King’s College Hospital service brings together breast radiology, breast surgery, histopathology, microbiology, infectious diseases and rheumatology within a structured multidisciplinary team supported by a formal standard operating procedure. Radiology is central to the pathway, not only in excluding malignancy and assessing disease extent, but also in obtaining tissue samples suitable for advanced microbiological and molecular testing. The article explains the importance of combining histopathology, conventional culture, polymerase chain reaction and metagenomic sequencing to distinguish infectious from non-infectious disease more accurately.
Early experience from 45 patients reviewed over two years suggests chronic inflammatory breast disease is not a single entity. While idiopathic granulomatous mastitis was the largest diagnostic group, a significant number of patients had identifiable infections, reinforcing the need to actively investigate infection before considering immunosuppression. The MDT enables more targeted treatment, with antimicrobial therapy for confirmed infection and immunosuppressive approaches where infection is excluded or inflammation persists. The wider message for radiology departments is that persistent breast inflammation requires systematic investigation, multidisciplinary collaboration and standardised pathways, allowing imaging teams to become active partners in precision diagnosis and personalised care.
To download and read the full article as a pdf please sign up to our newsletter.
The content on this page is provided by the individuals concerned and does not represent the views or opinions of RAD Magazine.
