Risk Management and Healthcare Policy (Oct 2023)
Risk Factors for Granulomatous Mastitis and Establishment and Validation of a Clinical Prediction Model (Nomogram)
Abstract
Yifei Zeng,1,2 Dongxiao Zhang,1 Na Fu,1 Wenjie Zhao,1 Qiao Huang,1 Jianchun Cui,3 Yunru Chen,4 Zhaolan Liu,4 Xiaojun Zhang,5 Shiyun Zhang,6 Khattak Mazher Mansoor3 1Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, People’s Republic of China; 2Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 3Liaoning Provincial People’s Hospital (Department of Thyroid and Breast Surgery, People’s Hospital of China Medical University), Shenyang, People’s Republic of China; 4Centre for Evidence-Based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China; 5Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China; 6Guang’ Anmen Hospital, China Academy of Chinese Medical Science, Beijing, People’s Republic of ChinaCorrespondence: Dongxiao Zhang, Department of Galactophore, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23, Art Museum Back Street, Dongcheng District, Beijing, 100010, People’s Republic of China, Tel +86 17862968916, Email [email protected]: This study aimed to explore the risk factors and clinical characteristics of granulomatous mastitis (GM) using a case-control study and establish and validate a clinical prediction model (nomogram).Methods: This retrospective case-control study was conducted in three hospitals in China from June 2017 to December 2021. A total of 1634 GM patients and 186 healthy women during the same period were included and randomly divided into the modeling and validation groups in a 7:3 ratio. To identify the independent risk factors of GM, univariate and multivariate logistic analyses were conducted and used to develop a nomogram. The prediction model was internally and externally validated using the Bootstrap technique and validation cohort. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the prediction model. Decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the clinical significance of the model.Results: The average age of GM patients was 33.14 years (mainly 20– 40). The incidence was high within five years from delivery and mainly occurred in the unilateral breast. The majority of the patients exhibited local skin alterations, while some also presented with systemic symptoms. On multivariate logistic analysis, age, high prolactin level, sex hormone intake, breast trauma, nipple discharge or invagination, and depression were independent risk factors for GM. The mean area under the curve (AUC) in the modeling and validation groups were 0.899 and 0.889. The internal and external validation demonstrated the model’s predictive ability and clinical value.Conclusion: Lactation-related factors are the main risk factors of GM, leading to milk stasis or increased ductal secretion. Meanwhile, hormone disorders could affect the secretion and expansion of mammary ducts. All these factors can obstruct or injure the duct, inducing inflammatory reactions and immune responses. Additionally, blunt trauma, depressed mood, and diet preference can accelerate the process. The nomogram can effectively predict the risk of GM.Keywords: granulomatous mastitis, risk factors, case-control study, nomogram, prediction model
