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Radiotherapy-associated alterations in granulomatous mastitis: Clinicopathological and immunohistochemical predictors of recurrence and differential diagnosis from breast tumors
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X. Zhao   , J.Y. Li , C.W. Zhang , L.J. Ma , Y. Zhao , X.H. Chen , X.L. Li |
| epartment of Breast Surgery, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei Province, China , lxlong201909@163.com |
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Abstract: (10 Views) |
Background: Granulomatous mastitis (GM) often recurs, and its clinical and pathological overlap with breast malignancies is especially problematic in patients with prior radiotherapy. To identify clinical, pathological, and immunohistochemical predictors of GM recurrence and to evaluate diagnostic challenges in the context of post-radiotherapy alterations. Materials and Methods: A retrospective cohort of 206 GM patients was analyzed (58 with recurrence, 148 without). Baseline clinical factors, pathological features, and immunohistochemical markers were compared. An XGBoost algorithm was applied to construct and validate a recurrence risk model. For patients with a history of breast radiotherapy, additional subgroup analysis was performed, incorporating imaging and pathology review to differentiate GM recurrence from tumor relapse. Results: Recurrence was associated with younger age (<35 years, 41.4% vs. 18.9%, P<0.001), higher prolactin levels (32.5±8.7 vs. 24.8±6.9 ng/mL, P<0.001), and higher BMI (26.4±3.8 vs. 24.1±3.2, P=0.007). Pathological indicators included multinucleated giant cells (31.0% vs. 12.2%, P<0.001), diffuse plasma cell infiltration (82.8% vs. 62.2%, P=0.003), and elevated Ki-67 (65.5% vs. 32.4%, P<0.001). The model achieved strong predictive performance (AUC = 0.89 training, 0.85 validation, 0.83 external). In post-radiotherapy patients, fibrotic distortion and atypical immune marker expression (Ki-67, PD-L1) frequently mimicked malignancy, highlighting the need for integrated clinicopathologic assessment. Conclusion: GM recurrence is driven by hormonal imbalance, immune dysregulation, and tissue injury. Radiotherapy-associated alterations exacerbate diagnostic overlap with breast tumors, underscoring the value of multidimensional prediction models for risk stratification and differential diagnosis. |
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| Keywords: Granulomatous mastitis, breast neoplasms, recurrence, radiotherapy, immunohistochemistry, risk factors, predictive models. |
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Full-Text [PDF 898 kb]
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Type of Study: Original Research |
Subject:
Radiation Biology
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