Ductal Lavage Versus Corticosteroids Therapy for Idiopathic Granulomatous Mastitis
Condition: Granulomatous Mastitis
MeSH terms: Mastitis; Granulomatous Mastitis
Study type: Interventional

Summary: 
      A single-arm, proof-of-concept trial has shown the safety and efficacy of ductal lavage as a
      treatment for idiopathic granulomatous mastitis patients (Manuscript accepted in Journal of
      Surgical Research 2018). In this multicenter, randomized, open-labeled, non-inferior trial,
      the investigators are going to enroll eligible granulomatous mastitis patients and randomized
      them into ductal lavage versus. corticosteroids therapy group. The primary endpoint of this
      study is the complete clinical response rate at 1 year after the enrollment. The aim of this
      study is to provide evidence for the management of idiopathic granulomatous mastitis patients
      .
    

Detailed description: 
      Non-lactational mastitis (NLM) consists of a broad spectrum of inflammatory breast diseases.
      Among them, periductal mastitis and idiopathic granulomatous mastitis(IGM) are the most
      commonly encountered in clinical practice. IGM can be diagnosed when all possible causes of
      granulomatous diseases (known mycobacterial or fungal infection, Wegener granulomatosis,
      sarcoidosis, etc.) are excluded. There is no consensus on the standard treatment of IGM
      patients. Surgery, oral corticosteroids, topical steroids, immunosuppressive therapy, and
      observation alone were all proposed as the treatment for IGM patients. However, all of the
      evidences are derived from retrospective studies. In a previous study, the investigators
      conducted a single-arm, proof-of-concept trial that showed the safety and efficacy of ductal
      lavage as a treatment for IGM patients. Ductal lavage is possible to spare the patients from
      corticosteroids therapy and or surgery. To further address this issue, the investigators are
      going to conduct this multicenter, randomized, open-labeled, non-inferior trial, to compare
      the efficacy and safety of ductal lavage and corticosteroids therapy. The aim of this study
      is to provide evidence for the management of IGM patients.
    

Intervention name(s): Ductal lavage; Corticosteroid therapy
Intervention type(s): Procedure; Drug
Intervention description(s): The patients received ductal lavage and breast massage every other day for two weeks. We used lidocaine (1%) for local anesthesia around the nipple. We used a lacrimal probe to identify 4-5 openings in the lactiferous ducts on the nipple and inserted the infusion cannula (21-23G). A total of 25ml of irrigation solution (5 ml of 2% lidocaine, 40 mg of triamcinolone acetonide, 20 ml of 0.9% saline and 1.0 g of ceftriaxone) was pumped into the ducts over 20-25 minutes. The patient returned to the clinic the next day for breast massage, and the cycle was repeated for two weeks.; Methylprednisolone(Common brand names: Medrol) or prednisone 20-40mg, qd for two weeks, then temper the dose gradually, and then 20mg qd for maintenance (The total duration of the treatment is 6 months).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment