Breast Tuberculosis: a retrospective analysis of the disease burden among three tertiary hospitals in Johannesburg

Abstract

INTRODUCTION: Breast Tuberculosis (TB) is a rare condition that has not been commonly reported. The incidence in developed countries has been reported as less than 0.1% of all surgical breast lesions and 3 − 4.5% of breast lesions in countries where TB is endemic. AIM: To outline the disease burden of breast TB as a quantitative analysis amongst three tertiary hospitals in Johannesburg, South Africa, with correlation to their clinical, demographic and imaging features. METHOD: A retrospective analysis over 18 months (01/01/2017 –20/06/2018) of all patients undergoing laboratory investigations for breast disease at the mammography departments of these three tertiary centres. RESULTS:The prevalence of breast TB was 2.5% (n = 62) of a total of 2516 patients. The median age of presentation was 38.5 years (IQR 33 –45). HIV status was known in 45 patients, of whom 36 were HIV-­‐infected (80%, 95% CI: [0.65 –0.90], p < 0.0001). Based on the ultrasound and/or mammogram findings, patients were classified under five categories: TB breast abscess (40.3%), inflammatory/disseminated (24.2%), isolated TB lymphadenitis (22.6%), nodular (11.3%) and sclerosing form (1.6%). Histology demonstrated necrotizing granulomatous inflammation in 57 cases (92%). Acid-­‐fast bacilli was positive in 8.1% (n = 5) of the cytology and 16.1% (n = 10) of the histology specimens. Culture for Mycobacterium tuberculosis was positive in 17 cases (27%). CONCLUSION: Knowledge of the varied clinical and radiological features is necessary to maintain a high degree of suspicion to prevent misdiagnoses, complications and inappropriate management