Nonsurgical management of breast infections in nonlactating women. A word of caution.
Nonsurgical management of breast infections in nonlactating women. A word of caution.
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发表时间：
1990-11
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通讯作者：
John J. Ferrara;J. Levêque;D. Dyess;Lorino Co
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作者：
John J. Ferrara;J. Levêque;D. Dyess;Lorino Co
传统上，传染性乳腺炎的治疗选择仅限于手术引流。随着经皮细针穿刺（FNA）的出现，非手术治疗可能是一种替代方法，但使用标准尚未确定。在30个月期间，22名妇女出现乳房感染。根据感染的临床阶段进行治疗。蜂窝织炎患者（n = 8）接受诊断性FNA/抗生素治疗。局灶性脓肿患者（n = 10）接受了空洞FNA/抗生素治疗。多房脓肿患者（n C = 3）接受了紧急手术引流。19名患者最初接受非手术治疗，9名（47%）患者痊愈;感染分期不影响结局。其余患者需要手术引流，发现两例癌，这些（以及所有）患者的细针穿刺细胞学检查均为阴性。所有患者在治疗期间均接受了乳房X线摄影。17例（77%）癌症被认为是低概率的。唯一一个乳房X光检查高度怀疑癌症的病人在活检时有脂肪坏死。79%的细菌培养呈阳性，几乎全部为革兰氏阳性球菌。四名患者也携带革兰氏阴性菌，其中两名与乳腺癌有关。结论：1）选择性乳腺感染可以成功地进行非手术治疗，2）FNA和乳房X线摄影在乳腺癌诊断中的准确性可能会受到并发感染的影响，3）发现革兰氏阴性乳腺感染时，应放弃非手术治疗，转而采用组织确认疾病过程。
UNLABELLED Management options for infectious mastitis have traditionally been limited to surgical drainage. With the advent of percutaneous fine needle aspiration (FNA), nonoperative treatment may be an alternative, though criteria for use have not been defined. During a 30-month period, 22 women presented with breast infection. Treatment was instituted based upon the clinical stage of infection. Patients with cellulitis (n = 8) were managed with diagnostic FNA/antibiotics. Those with focal abscess (n = 10) underwent FNA of the cavity/antibiotics. Patients with multiloculated abscess (n C = 3) underwent urgent surgical drainage. Of the 19 patients initially treated nonoperatively, resolution occurred in nine (47%); stage of infection did not effect outcome. Surgical drainage was required in the remainder; two cancers were found. FNA cytology in these (and all) patients was negative for malignancy. All underwent mammography during treatment. In 17 (77%) cancer was considered of low probability. The only patient with a mammogram highly suspicious for cancer had fat necrosis on biopsy. Bacterial cultures were positive in 79 per cent, virtually all with Gram (+) cocci. Four patients harbored Gram (-) organisms as well, two in concert with breast cancer. CONCLUSIONS 1) select breast infections can be successfully managed nonoperatively, 2) the accuracy of FNA and mammography in the diagnosis of breast cancer may be impaired by coincident infection, 3) the finding of a Gram (-) breast infection warrants abandonment of nonoperative management in favor of tissue confirmation of the disease process.