Abstract

A short cut review was carried out to establish whether needle aspiration was an alternative to incision and drainage in the management of breast abscess. Altogether 63 papers were found using the reported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated

Clinical scenario

A 28 year old lactating woman attends the emergency department with a history of pain in the breast. The patient has been taking antibiotics prescribed by her general practitioner for two days without relief. On examination she has an abscess in her left breast. You wonder whether needle aspiration is an option or whether she needs formal incision and drainage.

Three part question

In [a patient with a breast abscess ] is [needle aspiration as good as incision and drainage] in [achieving resolution and minimising recurrence]?

Search strategy

Medline 1966-01/04 using the OVID interface. [breast abscess$.mp OR {(exp breast OR breast$.mp) AND (exp abscess OR abscess$.mp)}] AND (aspiration.mp OR exp needles OR needle$.mp).

Search outcome

Altogether 63 papers were found, of which six were relevant to the question and of sufficient quality for inclusion (see table 2).

Comment(s)

There are no good studies to answer the question. Most of the studies involved small numbers and are uncontrolled descriptions of case series. In these series the smaller the abscess the better is the outcome and lower is the recurrence rate. Needle aspiration may be more effective when combined with antibiotics—but again there are no controlled studies to allow us to conclude this definitely. A randomised controlled trial is needed.

CLINICAL BOTTOM LINE

Needle aspiration may be an effective first treatment in small breast abscesses.