Ultrasound-guided microwave ablation versus conventional surgery for Granulomatous Lobular Mastitis: A two-center retrospective comparative stud

Abstract

Background Granulomatous lobular mastitis (GLM) is a chronic inflammatory breast disease that causes substantial pain, cosmetic deformity, and psychosocial distress. Evidence directly comparing ultrasound-guided microwave ablation (MWA) with conventional surgery (CS) remains limited. Methods We conducted a two-center retrospective cohort study of consecutive women with core needle biopsy-confirmed GLM treated between March 2020 and February 2025. Treatment allocation was non-random and reflected routine clinical decision-making. The primary outcomes were overall cure and recurrence. Secondary outcomes included perioperative resource utilization and patient-reported outcomes assessed with a BREAST-Q domain-based questionnaire adapted for GLM follow-up. Baseline balance was described with both P values and standardized mean differences (SMDs). Results Among 233 patients (MWA, n = 102; CS, n = 131), overall cure was achieved in 97.06% and 96.18% of patients, respectively (risk difference, 0.88 percentage points; 95% CI, −3.76 to 5.51; P = 1.000). Recurrence occurred in 4.90% of the MWA group and 3.82% of the CS group (risk difference, 1.09 percentage points; 95% CI, −4.24 to 6.41; P = 0.751) during a median follow-up of 18.5 months. Compared with CS, MWA was associated with lower estimated blood loss, shorter procedure time, lower postoperative drainage burden, and shorter hospitalization (all P  < 0.001), while total hospitalization cost did not differ significantly. Questionnaire scores favored MWA for sexual well-being, breast satisfaction, and scar satisfaction, whereas psychological well-being, chest physical well-being, and satisfaction with the medical team were similar between groups. SMDs indicated some baseline imbalance, particularly for multiple-quadrant involvement and ultrasound lesion size. Conclusions In this retrospective observational comparison, MWA and CS were associated with similarly high cure rates and low recurrence. MWA was additionally associated with lower perioperative burden and better breast- and scar-related satisfaction. Prospective studies with standardized co-interventions, confounding adjustment, and validated patient-reported outcome assessment are warranted.