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. 2012 Feb;7(1):32-38.
doi: 10.1159/000336547. Epub 2012 Feb 21.

Breast Abscesses: Diagnosis, Treatment and Outcome

Markus Fahrni  1 , Esther I Schwarz, Sylvia Stadlmann, Gad Singer, Nik Hauser, Rahel A Kubik-Huch
Affiliations

Breast Abscesses: Diagnosis, Treatment and Outcome

Markus Fahrni et al. Breast Care (Basel). 2012 Feb.

Abstract
in English, German

BACKGROUND: The aim of our study was to analyze diagnostic results, different treatment modalities, and the outcome of patients with breast abscesses treated at our institution in a multi-modality breast team, to determine whether minimally invasive treatments are successful. METHODS: 110 patients with mastitis and suspected breast abscesses at our institution between January 2000 and end of September 2007 were retrospectively analyzed. Abscesses were diagnosed using ultrasonography (US), and the material obtained using US-guided fine needle aspiration (FNA) was further examined. RESULTS: 29% of the patients were treated conservatively with antibiotics only, 51% were treated with US-guided FNA or drainage placement. 11% of the patients underwent additional surgery after minimally invasive treatment (i.e. conversion rate). 9% of the patients underwent primary surgery. Early complications occurred in 7% of patients treated minimally invasive but not in patients treated with surgery alone. Late complications occurred in 5% of patients who underwent minimally invasive treatments and in 30% of patients who underwent surgery. CONCLUSIONS: US-guided FNA as a minimally invasive therapy in combination with antibiotics was found to successfully treat most breast abscesses and, in cases where a larger volume of pus was involved, the placement of an additional drainage catheter was effective.

Hintergrund: Ziel unserer Studie war es, die diagnostischen Ergebnisse, die verschiedenen Therapiemodalitäten und das Behandlungsergebnis von Patienten und Patientinnen mit Brustabszessen, die durch das interdisziplinäre Brustteam unserer Institution behandelt wurden, zu analysieren und herauszufinden, ob das minimal invasive Therapieschema erfolgreich ist.

Methoden: Die Daten von 110 Patienten mit Mastitis und Verdacht auf Abszessbildung, die zwischen Januar 2000 und September 2007 in unserer Institution behandelt wurden, wurden retrospektiv ausgewertet. Die Abszesse wurden mittels Ultraschall (US) diagnostiziert, und das mittels US-gesteuerter Feinnadelaspiration (FNA) gewonnene Material wurde weiter analysiert.

Ergebnisse: 29% der Patienten wurden konservativ mit Antibiotika behandelt, bei 51% wurde zusätzliche eine US-gestützte FNA oder Drainageeinlage durchgeführt. 11% der Patienten wurden nach der US-gestützten Intervention operiert (= Konversionsrate). 9% der Patienten wurden primär operiert. Frühkomplikationen traten bei 7% der minimal invasiv behandelten und bei keinem der primär operierten Patienten auf. Spätkomplikationen wurden hingegen bei 5% der minimal invasiv behandelten und 30% der primär operierten Patienten beobachtet.

Schlussfolgerungen: Die minimal invasive US-gestützte FNA ist in Kombination mit Antibiotikagabe bei der Behandlung von Brustabszessen in den meisten Fällen erfolgreich. Bei großen Abszessen empfiehlt sich die ergänzende Einlage eines Drainagekatheters.

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Figures

Fig. 1
Fig. 1
Ultrasound images of a breast abscess and US-guided FNA in a woman of 53 years. (A) Shows axial US image of a large hypoechogenic lesion (collection of pus) with perifocal hyperechogenic tissue; (B) shows the corresponding longitudinal image; (C, D) following US-guided insertion of a needle, the material of the abscess is aspirated.
Fig. 2
Fig. 2
US-guided drainage of an abscess formation in a 28-year-old patient. (A, B) shows the tools used for drainage of an abscess and the catheter tip (marked with an arrow) in the abscess cavity (indicated with short arrows).
Fig. 3
Fig. 3
Contrast-enhanced MRI scans of a retroareolar abscess in the right breast of a 70-year-old patient with non-puerperal mastitis. (A) Shows the T2-weighted axial sequence; (B-D) dynamic contrast-enhanced T1-weighted MRI sequences (subtracted images) with the retroareolar florid abscess noticeably demarcated. A perifocal zone of diffuse inflammatory enhancement is marked with small arrows.
Fig. 4
Fig. 4
Papanicolou staining of a cytologic smear from fine needle aspirates from a 61-year-old woman and a 63-year-old woman shows (A) acute inflammation with numerous neutrophil granulocytes, scattered macrophages, and cell debris in the background. Multinucleated giant cells engulfing necrotic fat cells are marked with an arrow (magnification, 20 ×). (B) A homogeneous population of poorly cohesive cells with nuclear atypia, with intracytoplasmic vacuoles present due to mucin production (indicated with arrows) (magnification, 40 ×).
See this image and copyright information in PMC

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