Clinical, diagnostic and therapeutic management of patients with breast tuberculosis: Retrospective analysis of 16 Cases

Breast tuberculosis (TB) is a rare form of extrapulmonary tubercular infection. The clinical presentations, diagnostic difficulties and therapeutic approach of breast TB are not well understood. This study aimed to review the nonspecific clinical presentations, diagnostic difficulties and therapeutic approach of breast TB. Sixteen female patients diagnosed with breast TB between 2016 and 2019 were retrospectively reviewed. The mean age of the patients was 36.4 years, and the most common complaints were breast mass and pain. While 31.2% of the cases had a physical examination with suspicions for malignancy, 43.5% of the patients had Breast Imaging Reporting and Data System (BIRADS) 3 lesions that suggested malignancy radiologically. Definitive diagnosis was based on histopathologic examination through core needle biopsy, excisional biopsy, and open biopsy taken from the abscess wall during drainage. All patients were treated with standard anti-TB therapy for 6 months. Thirteen patients recovered with standard therapy, while extended treatment for 9 to12 months was needed in 3 (18.8%) cases. Surgery was carried out in 6 cases, and 2 patients developed recurrence. Breast TB can be easily confused with breast cancer, suppurative abscess, and other causes of granulomatous mastitis, both clinically and radiologically. A multidisciplinary approach is required to prevent diagnostic delays and unnecessary surgical interventions. Although anti-TB therapy is the mainstay treatment of breast TB, surgery is usually indicated in patients refractory to medical treatment.