The available literature on treatment of breast abscesses is imperfect, with no clear consensus on drainage, antibiotic therapy, and follow-up.
Breast abscesses that develop in the puerperal period generally have a better course than nonpuerperal abscesses, which tend to be associated with longer treatment times and a higher rate of recurrence. Although the traditional approach of surgical incision and drainage is no longer the recommended treatment, there are no clear guidelines for management of this clinical condition. Radiologists who regularly perform breast ultrasonography will likely encounter patients with breast abscesses. Because most findings are smaller than 1 cm, located within a duct, and thus sometimes not visible after a single pass, vacuum-assisted devices help improve the accuracy of sampling. Most commonly performed with US or MR imaging guidance, percutaneous biopsy methods are helpful in diagnosis and management of ductal findings. Malignant diseases of the ducts include ductal carcinoma in situ, invasive ductal carcinoma, and Paget disease. Benign diseases of the ducts include duct ectasia, blocked ducts, inflammatory infiltrates, periductal mastitis, apocrine metaplasia, intraductal papillomas, and papillomatosis. The most common finding with all modalities is ductal dilatation with a focal or diffuse abnormality. Imaging evaluation of the ductal system usually entails a combination of mammography, galactography, ultrasonography (US), and in some cases magnetic resonance (MR) imaging. Each breast is composed of eight or more ductal systems, with most disease arising in the terminal ductal-lobular unit. The differential diagnosis for an intraductal mass is broad and includes inspissated secretions, infection, hemorrhage, solitary or multiple papillomas, and malignancy. © RSNA, 2013.ĭuctal disease is an important, often overlooked, and poorly understood issue in breast imaging that results in delays in diagnosis and patient care. Preoperative image-based identification and sampling of abnormal lymph nodes that have a high positive predictive value for metastases is an extremely important component in the management of patients with invasive breast cancer. Computed tomography and radionuclide imaging play a lesser role in imaging the axilla. Magnetic resonance imaging is also useful, with the added benefit of providing a global view of both axillae. Core biopsy has been shown to be equal in safety to fine needle aspiration and has a significantly lower false-negative rate. US-guided lymph node sampling, especially with core biopsy, is invaluable in confirming the presence of a metastasis in a suspicious node. Morphologic criteria, such as cortical thickening, hilar effacement, and nonhilar cortical blood flow, are more important than size criteria in the identification of metastases. Ultrasonography (US) is the primary imaging modality for evaluating axillary nodes. The pathologic features of nodal metastases illuminate the imaging appearances of these nodes, as depicted with all modalities.
Knowledge of the important anatomic landmarks of the axilla is important in finding and accurately reporting suspicious lymph nodes. The benefit of preoperative identification of axillary metastases is that it allows the surgeon to proceed directly to ALND and to avoid an unnecessary SLNB and the need for a second surgical procedure involving the axillary nodes. Patients with positive SLNB results generally undergo axillary lymph node dissection (ALND). Sentinel lymph node biopsy (SLNB) is the definitive method to exclude axillary metastases. Identifying the presence of axillary node and internal mammary node metastases in patients with invasive breast cancer is critical for determining prognosis and for deciding on appropriate treatment.
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