Ultrasound Guided Needle Aspiration versus Surgical Drainage in the management of breast abscesses: a Ugandan experience

Abstract

Background: Despite breast abscess becoming less common in developed countries, it has remained one of the leading causes of morbidity in women in developing countries. A randomized controlled trial was conducted at Mulago hospital complex in Kampala Uganda to establish whether ultrasound guided needle aspiration is a feasible alternative treatment option for breast abscesses.

Results: A total of 65 females with breast abscess were analyzed, of these 33 patients were randomized into the ultrasound guided needle aspiration and 32 patients in the Incision and drainage arm. The mean age was 23.12, most of them were lactating (66.2%), primipararous (44.6%) with peripheral abscesses (73.8%) located in the upper lateral quadrant (56%).The mean breast size was 3.49 cm. The two groups were comparably in demographic characteristic and breast abscess size. Survival analysis showed no difference in breast abscess healing rate between the two groups (Log rank 0.24 df 1 and P = 0.63). Incision and drainage was found to be more costly than ultrasound guided aspiration (cost effective ratio of 2.85).

Conclusion: Ultrasound guided needle aspiration is therefore a feasible and cost effective treatment option for both lactating and non lactating breast abscesses with a diameter up to 5 cm by ultrasound in an immune competent patient.

Figure 1

A sonogram of a 22 yrs old female showing a right breast abscess. Note the oval shape of the abscess measuring 2.64 cm by 1.54 cm before aspiration under U.S.S guidance.

Figure 2

U.S.S guided needle aspiration of the Right breast abscess of the above patient. Note the needle in the breast abscess cavity during the aspiration process (see the arrows). Incision and drainage group had a recurrence rate of 3.1% (1/32) during the follow up period. 5 (7.7%) women of the 65 were lost to follow up, 4 patients were from the Ultrasound guided aspiration group and 1 patient from Incision and drainage group. Of the 4 patients in the aspiration group, 2 missed the 2nd visit and the other 2 patients missed the 3rd visit. The patient in the Incision and drainage group lost to follow up in the 3rd visit.

Figure 3

Right breast after U.S.S guided needle Aspiration of the Abscess of the above patient. Note the disappearance of the abscess cavity leaving behind inflamed tissues as indicated by arrows.

Figure 4

Survival Function.

Figure 5

Hazard Function.