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Rate of malignancies in breast abscesses and argument for ultrasound drainage.

Scott BG, Silberfein EJ, Pham HQ, Feanny MA, Lassinger BK, Welsh FJ, Carrick MM

Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza #404D, Houston, TX 77030, USA. Bgscott@bcm.edu <Bgscott@bcm.edu>

BACKGROUND: Biopsy of a breast abscess wall has been performed for years without evidence. Aspiration of breast abscesses has been increasing in popularity without widespread acceptance. METHODS: A 10-year retrospective review of 206 surgical biopsies after incision and drainage of breast abscesses. A literature review of breast abscess treated with ultrasound-guided aspiration. RESULTS: Over 10 years, 4.37% (9/206) patients were diagnosed with malignancy in the abscess cavity wall tissue. None of the 197 patients with a negative biopsy returned with breast cancer. Single, multiple, and combined aspiration success rates of 79.8% (364/458), 11.0% (50/458), and 90.9% (482/532) with surgical intervention necessary in 9.1% (50/532). Ultrasound versus hand guidance (92.5% versus 81.9 %, P < .01) improved success rate. CONCLUSIONS: The rate of associated malignancies with breast abscess is very low and does not warrant mandatory surgical drainage. The use of ultrasound-directed aspiration of breast abscesses is effective and should be first-line therapy.

Published 12 December 2006 in Am J Surg, 192(6): 869-72.
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