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Título

STANDARDIZATION OF THE LABORATORY RESEARCH PROTOCOL AND ANATOMOPATHOLOGICAL FOR THE DIAGNOSIS OF BREAST GRANULOMATOUS INJURIES

Título em Inglês

STANDARDIZATION OF THE LABORATORY RESEARCH PROTOCOL AND ANATOMOPATHOLOGICAL FOR THE DIAGNOSIS OF BREAST GRANULOMATOUS INJURIES

Introdução

Introduction: Granulomatous breast lesions are multifactorial conditions, with clinical, mammographic and ultrasound findings like those observed in cases of breast carcinoma. Histological evaluation can present key characteristics to define the lesion pattern. Although this entity is rarely reported in the literature, it is associated with inflammatory conditions such as Ectasia Ductal and foreign body reaction. However, it can also be associated with agents such as bacteria, fungi, and parasites. Furthermore, idiopathic causes and exclusion diagnosis, such as sarcoidosis, can be included in the etiology of the process.

Objetivos

Objective: To establish a correlation between the anatomopathological diagnosis and the laboratory investigation by culture for breast granulomatous lesions diagnosis, with validation of the sample’s analysis protocol.

Métodos

Method: Samples were selected from 17 women treated at the Mastology Service of a Public Hospital in Brazil, with a historical and physical examination suspected of breast granulomatous lesion and previous clinical indication of breast core biopsy. Collection of samples was guided by USG. In turn, they were stored in a blood culture flask (BD BACTECTM) to perform culture tests by automation (VITEK2); bacterioscopy and fungi exams; and acid resistant bacillus (ARB) tests, at the Laboratory of Clinical Analysis. Simultaneously, core biopsy samples, fixed in 10% buffered formaldehyde, were sent to the Laboratory of Pathological Anatomy, for morphological evaluation and research of ARB, fungi and other bacteria, using the Ziehl-Nielsen, Grocott, PAS and GRAM histochemical methods.

Resultados

Results: Of the 17 samples, 11 had a chronic inflammatory response pattern with a non-lobulocentric granulomatous reaction component and 1 had a lymphocytic mastitis pattern. The 5 patients with morphological pattern of lobulocentric granulomatous mastitis presented positive culture, 4 for Corynebacterium kroppenstedtil and one for Staphylococcus hominis. Sensitivity, Specificity, Positive Predictive Value and Negative Predictive Value in this sample was 100%.

Conclusões

Conclusion: The clinical and radiological aspects can bring difficulties that obscure the diagnostic and etiological interpretation of granulomatous lesions. Thus, the morphological details observed in the anatomical pathological examination and the use of the laboratory investigation protocol with standardization of histochemical reactions associated with the use of tools for microbiological diagnosis show increased sensitivity and specificity for the detection of specific etiologic agents in granulomatous mastitis.

Palavras Chave

Área

DETECTION / DIAGNOSIS - Pathology