Risk Factors and the Role of the Albumin-to-Globulin Ratio in Predicting Recurrence Among Patients with Idiopathic Granulomatous Mastitis

Figures & data

Figure 1 The study flow diagram for selection of patients.

Table 1 Baseline Characteristics and Comparison of Variables Among IGM Recurrence Groups

	IGM Recurrence
	No (n=69)	Yes (n=16)	Total (n=85)	P values
Age (years)	37.64±9.79	31.44±7.17	36.47±9.63	0.019^a
Follow-up time (months)	41±18.91	35.63±19.02	39.99±18.93	0.309^a
BMI (kg/m^2)	28.38±4.63	26.87±5.04	28.10±4.72	0.249^a
Marital status
Single	4 (5.8%)	5 (31.3%)	9 (10.6%)	0.010^b
Married	65 (94.2%)	11 (68.8%)	76 (89.4%)
Parity
Nulliparous	5 (7.2%)	4 (25%)	9 (10.6%)	0.060^b
Parous	64 (92.8%)	12 (75%)	76 (89.4%)
Breastfeeding
No	11 (15.9%)	5 (31.3%)	16 (18.8%)	0.170^b
Yes	58 (84.1%)	11 (68.8%)	69 (81.2%)
The last delivery (years)	7±6	5±6	6±6	0.032^d
Smoking
No	53 (76.8%)	7 (43.8%)	60 (70.6%)	0.014^b
Yes	16 (23.2%)	9 (56.3%)	25 (29.4%)
Lesion side
Right breast	35 (50.7%)	8 (50%)	43 (50.6%)	0.958^c
Left breast	34 (49.3%)	8 (50%)	42 (49.4%)
Lesion localization
Central	19 (27.5%)	6 (37.5%)	25 (29.4%)	0.955^b
Lower-inner quadrant	4 (5.8%)	1 (6.3%)	5 (5.9%)
Upper-inner quadrant	18 (26.1%)	3 (18.8%)	21 (24.7%)
Multiple	5 (7.2%)	1 (6.3%)	6 (7.1%)
Lower-outer quadrant	3 (4.3%)	1 (6.3%)	4 (4.7%)
Upper-outer quadrant	20 (29%)	4 (25%)	24 (28.2%)
Biopsy
TRU-CUT	36 (52.2%)	13 (81.3%)	49 (57.6%)	0.043^b
Excision	21 (30.4%)	0 (0%)	21 (24.7%)
Incision	2 (2.9%)	0 (0%)	2 (2.4%)
SM	9 (13%)	3 (18.8%)	12 (14.1%)
FNAC	1 (1.4%)	0 (0%)	1 (1.2%)
Disease severity
Mild	31 (44.9%)	4 (25%)	35 (41.2%)	0.057^c
Moderate	25 (36.2%)	11 (68.8%)	36 (42.4%)
Severe	13 (18.8%)	1 (6.3%)	14 (16.5%)
Treatment
Steroid and MTX	13 (18.8%)	1 (6.3%)	14 (16.5%)	0.097^b
Observation	15 (21.7%)	0 (0%)	15 (17.6%)
Antibiotic and steroid	7 (10.1%)	3 (18.8%)	10 (11.8%)
Incision and Drainage	24 (34.8%)	9 (56.3%)	33 (38.8%)
SM	8 (11.6%)	2 (12.5%)	10 (11.8%)
SM and steroid	2 (2.9%)	1 (6.3%)	3 (3.5%)
WBC (10^9/L)	8.1±2.6	9.1±3.1	8.5±2.6	0.056^d
CRP (mg/dl)	2.2±6.1	1.4±12.1	2±6.3	0.791^d
Sedimentation (mm/h)	20±20	21±13	20±20	0.791^d
HB (gr/dl)	12.7±1.4	12.4±1.9	12.6±1.5	0.805^d
Neutrophil (10^9/L)	4.9±2.5	6.2±2.6	5±2.8	0.109^d
Lymphocyte (10^9/L)	2.16±0.65	2.33±0.65	2.19±0.65	0.347^a
PLT (10^9/L)	259±103	274.5±97	259±102	0.682^d
ALB (g/L)	4.3±0.45	4.1±0.1	4.3±0.5	0.010^d
Protein (g/L)	7.6±0.55	7.85±0.47	7.6±0.5	0.018^d
Globulin (g/L)	3.24±0.36	3.73±0.22	3.33±0.39	<0.001^a
AGR	1.3±0.28	1.09±0.13	1.26±0.23	<0.001^d
NLR	2.27±1.82	2.55±1.55	2.31±1.73	0.472^d
PLR	131.2±70.86	115.04±65.01	129.5±69.83	0.421^d

Notes: ^aStudent’s t-test with mean ± standard deviation (SD). ^bFisher’s Exact test with n (%). ^cChi-Square with n (%). ^dMann Whitney U-test with median ± interquartile range (IQR). Statistically significant results (p < 0.05) are shown in bold.

Abbreviations: IGM, Idiopathic granulomatous mastitis; BMI, Body Mass Index; WBC, White blood cell count; CRP, C-reactive protein; HB, Hemoglobin; PLT, platelets; ALB, Albumin; AGR, Albumin-to-globulin ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SM, Segmental mastectomy; FNAC, Fine needle aspiration cytology; MTX, Methotrexate.

Table 2 ROC Analysis Results and Sensitivity, Specificity, PPV, NPV, and Likelihood Ratio (+) Values of ALB, Protein, Globulin, and AGR Parameters in IGM Recurrence Prediction

	ALB	Protein	Globulin	AGR
AUC (95% CI)	0.707 (0.592–0.823)	0.689 (0.546–0.833)	0.870 (0.790–0.949)	0.869 (0.790–0.947)
P values	0.010	0.019	<0.001	<0.001
Cut off	≤ 4.15	≥7.35	≥ 3.35	≤ 1.179
Sensitivity (95% CI)	0.812 (0.536–0.950)	1 (0.759–1)	1 (0.759–1)	0.937 (0.677–0.996)
Specificity (95% CI)	0.695 (0.571–0.797)	0.260 (0.165–0.382)	0.594 (0.469–0.708)	0.768 (0.648–0.857)
PPV (95% CI)	0.382 (0.226–0.563)	0.238 (0.146–0.361)	0.363 (0.228–0.522)	0.483 (0.305–0.666)
NPV (95% CI)	0.941 (0.827–0.984)	1 (0.781–1)	1 (0.893–1)	0.981 (0.888–0.999)
LR+ (95% CI)	2.66 (1.74–4.09)	1.35 (1.17–1.55)	2.46 (1.85–3.27)	4.04 (2.58–6.32)

Note: Statistically significant results (p < 0.05) are shown in bold.

Abbreviations: ROC, Receiver Operating Characteristic; PPV, positive predictive value; NPV, negative predictive value; AUC, Area under curve, CI, Confidence interval; ALB, Albumin, AGR, Albumin-to-globulin ratio.

Table 3 The Success of Cut-off Values Determined by ROC Analysis in IGM Recurrence Prediction

	Cut-Off	IGM Recurrence		Total
		No	Yes
ALB	>4.15	48	3	51
	≤4.15	21	13	34
Protein	<7.35	18	0	18
	≥7.35	51	16	67
Globulin	<3.35	41	0	41
	≥3.35	28	16	44
AGR	>1.179	53	1	54
	≤1.179	16	15	31
Total		69	16	85

Abbreviations: ALB, Albumin; AGR, Albumin-to-globulin ratio.

Figure 2 Boxplot of the distribution of (A) ALB (Albumin), (B) Protein, (C) Globulin and (D) AGR (Albumin-to-globulin ratio) values among IGM (idiopathic granulomatous mastitis) recurrence groups. Asterisk (*): Extreme outliers are data points that are more extreme than Q1- 3 * IQR or Q3 + 3 * IQR. Circle (^o): Mild outliers are data points that are more extreme than Q1- 1.5 * IQR or Q3 + 1.5 * IQR.

Figure 3 The receiver operating characteristic (ROC) curve and the area under the ROC (AUC) of (A) ALB (Albumin), (B) Protein, (C) Globulin and (D) AGR (Albumin-to-globulin ratio) values in IGM (idiopathic granulomatous mastitis) recurrence prediction.

Table 4 The Results of Univariate and Multivariate Binary Logistic Regression Analysis Performed to Determine the Risk Factors That are Effective in IGM Recurrence

	Univariate		Multivariate
	P values	OR (CI 95%)	P values	OR (CI 95%)
Marital status Single against married	0.007	7.39 (1.71–31.8)	ns	–
Smoking Yes, against no	0.012	4.26 (1.37–13.2)	0.044	4.45 (1.04–18.9)
Age	0.023	0.91 (0.84–0.99)	ns	–
The last birth	0.049	0.87 (0.76–0.99)	ns	–
AGR	<0.001	49.7 (6.08–405.8)	<0.001	50.7 (5.93–434.1)
≤1.179 against ≥1.179
Multivariate model: Nagelkerke R Square=0.527, Classification accuracy: 88.2%

Note: Statistically significant results (p < 0.05) are shown in bold.

Abbreviations: ns, not significant; OR, Odds ratio; CI, Confidence interval; AGR, Albumin-to-globulin ratio.