How is granulomatous mastitis diagnosed?

The diagnostic workup for granulomatous mastitis follows the same general steps used for other breast diseases—primarily involving a detailed medical history, symptom assessment, and clinical physical examination. Additionally, supportive laboratory tests and imaging studies are routinely employed in clinical practice. So, how is granulomatous mastitis diagnosed? Below, we address this question.

How Is Granulomatous Mastitis Diagnosed?

1. Ultrasound Examination

Ultrasound enables visualization of breast swelling and can identify abscess formation. If a distinct abscess is present, ultrasound-guided aspiration or drainage may be performed. Moreover, ultrasound typically reveals a characteristic “sand-like” dynamic appearance within an established abscess. In cases where the lesion remains intact (i.e., without tissue destruction), multiple hypoechoic or anechoic foci may be observed within the mass.

2. Histopathological Biopsy

Histopathological biopsy must be tailored to individual patients. Obtaining adequate tissue specimens is critical for diagnosing granulomatous mastitis. The decision to perform biopsy—and the specific technique employed—depends on each patient’s unique clinical presentation and disease stage.

3. Complete Blood Count (CBC)

A CBC helps assess whether infection is present. In infected patients, white blood cell count typically rises, while eosinophil levels decrease significantly. Bacterial culture and antimicrobial susceptibility testing may also be conducted using aspirated breast abscess fluid to identify the causative pathogen.

Additional Information: Symptoms of Mastitis

1. Stasis Mastitis

This type commonly occurs around one week postpartum, particularly among first-time mothers lacking breastfeeding experience, leading to milk stasis and inadequate emptying of the breasts. Patients typically experience varying degrees of bilateral breast distension and pain, mild fever, breast fullness, and tenderness. Symptoms usually improve markedly after milk expression.

2. Suppurative Mastitis

Suppurative mastitis is often caused by bacterial invasion—commonly Staphylococcus or Streptococcus species—through cracked or fissured nipples. Milk stasis postpartum predisposes to infection; once bacteria enter the lactiferous ducts, they may progress into the glandular parenchyma, ultimately resulting in suppurative mastitis. Furthermore, acute mastitis tends to spread rapidly.

3. Systemic Symptoms

If acute mastitis remains untreated, systemic manifestations may develop. As the condition progresses, patients may experience fever, chills, tachycardia, worsening breast pain and swelling, and erythema of the overlying skin. Prompt medical evaluation and treatment are essential at this stage to prevent serious complications.

The above outlines the diagnostic approach to granulomatous mastitis. We hope this information proves helpful.