Ultrasound-Guided Percutaneous Aspiration for the Treatment of Breast Abscess at a Tertiary Care Center in the Developing World

Abstract

Purpose: Percutaneous ultrasound (US)-guided aspiration is the first line of management for breast abscess.Our study aimed to look at the success of US-guided percutaneous drainage in managing breast abscesses at a tertiary care center and additionally to look for any correlation between US features and failure rate.Methods: A retrospective review of the radiology database at a tertiary care hospital in Pakistan was done to identify 54 patients through non-probability convenience sampling who underwent a US-guided percutaneous aspiration with laboratory confirmation of abscess. A treatment course was observed for the development of complications or failure of treatment. A chi-square test was performed to correlate US features and patient characteristics with outcomes of treatment (p<0.05). Fisher's exact test was applied to evaluate the success of aspiration in small versus large abscesses, and in lactating versus non-lactating patients.Results: 75% of all women were successfully able to avoid surgery. Specifically, 80.6% of all lactating women and 66.7 % of non-lactating women with breast abscesses were successfully managed with US-guided percutaneous aspiration. Across a variety of parameters measured, including pathological and etiological factors, as well as features on imaging, no significant association was established between the variables and the failure of the intervention.Conclusion: Low morbidity and high patient satisfaction rates make percutaneous aspiration preferable to surgical intervention as a first-line treatment of breast abscess. Early use of antibiotics is recommended as an adjunct to drainage.

Breaking the Barrier: A Study on Multi‐drug Resistance in Breast Abscess at an Academic Malaysian Hospital

“…Despite inadequate evidence to show that MDRO led to repeated aspirations based on previous literature [38], our study had sufficient evidence to suggest that the presence of MDRO increased the need for surgical incision and drainage to resolve breast abscess. As mentioned earlier, aspiration is acknowledged as a better option to surgical drainage given its lower morbidities [15][16][17][18]. Treatment of breast abscess should be discussed between a multidisciplinary team which include the infectious disease and microbiology specialists to improve the clinical outcome of breast abscess patients.…”

“…According to a report from Australia, 7% of all non-lactational breast abscesses are caused by MRSA [14]. In terms of treatment modalities, aspiration is considered better than surgical drainage as it has lower morbidity in terms of reduced scarring and healing time, shorter hospitalisation, reduction of injury to lactational ducts, higher patient satisfaction rates, and more cost effective [15][16][17][18]. However, about 20% of women infected by MRSA who initially underwent aspiration subsequently require surgical drainage [19].…”

A Randomized Controlled Trial Comparing Ultrasonography-Guided Needle Aspiration and Surgical Drainage for the Management of Breast Abscess

“…However, there is a rising trend toward employing minimally invasive procedures [ 1 ]. The needle aspiration is considered to be an alternative and less invasive approach for the treatment of BA [ 10 ]. The Society of Interventional Radiology (SIR) defines image‐guided percutaneous aspiration as "evacuation or diagnostic sampling of a fluid collection with the use of a catheter or a needle during a single imaging session, with the removal of the catheter or needle immediately after the aspiration" [ 11 ].…”

“…Recent studies have supported the use of USG-guided aspiration of the BA, as it has multiple advantages. These include less scarring, a continuation of breastfeeding, and less expensive than the conventional ID as it does not need hospitalization and anesthesia [ 10 , 13 ]. However, multiple aspirations are often required.…”

A comparison of the outcomes of a novel technique of Mini-Incision and Self-Express (MISE) for breast abscess with the conventional techniques: a retrospective comparative cohort study

“…Established treatments include incision and drainage (I&D) and needle aspiration. Although the latter results in no scar and is minimally invasive, it often requires repeated aspirations 2 and may not be possible in cases when the abscesses are large 3 multiloculated or have necrotic tissues. Conversely, I&D drains the abscess in a single episode but will leave a scar and require general anaesthesia.…”