Breast tuberculosis: clinical spectrum, diagnostic dilemmas and management

Background: Tuberculosis breast is a less known form of extrapulmonary tuberculosis. It poses diagnostic difficulties and confused with breast carcinoma and pyogenic abscess. Objective of the study was to determine the varied presentations of breast tuberculosis, diagnostic difficulties and surgical treatments.Methods: Study was conducted in Department of Surgery at Shri Guru Ram Rai Institute of Health and Medical Sciences, Dehradun, Uttarakhand, India. 651 patients with breast diseases over two years from September 2015- August 2017 were seen at the institution out of which 31 clinically diagnosed patients of breast tuberculosis, confirmed by laboratory work-up, were included in this study. Information regarding demographic details, clinical presentation, cytology, histopathology and management was noted.Results: All patients were females with mean age of 32.5years and out of them 15(48.38%) patients were having breast abscess, 10(32.25%) presented with lump breast and 6(19.35%) with lump with multiple draining sinuses and scars. 27(87.1%) patients had primary breast tuberculosis. Histopathology and TB-PCR reliably helped in diagnosing the disease.Conclusions: The presentation of breast TB is variable, and diagnosis is usually delayed. It should always be kept in mind as differential diagnosis of breast lump and pyogenic abscess. The disease can be diagnosed through pathological tests and a high suspicion. The definite treatment is adequate anti-tuberculosis chemotherapy and surgical excision or drainage especially in recurrent abscesses.