Between January 2009 and July 2011 seven patients (age range 28–71 years; mean age 43.2 years) were diagnosed with chronic post-operative intraglandular MF. Chronic post-operative intraglandular MF was defined as the presence of a fistula not resolved after 8 weeks' conservative treatment, with scarce but constant suppuration, no abscess formation, and ultrasound examination showing an intraglandular hypoechoic tubular image corresponding to the fistulous tract of the MF (). The patient information is shown in . All the patients had a history of surgery: incision and drainage of a non-lactating abscess (n=4), reduction mammoplasty (n=2) and excisional biopsy of a benign lesion (n=1). This study was approved by our institutional ethics committee and informed consent was obtained from the participants.
Figure 1 A 71-year-old female with mammillary fistula. (a) Sonogram showing hypoechoic tract (arrows). (b) Sonogram showing corticoid injection into the tract (arrows). (c) Sonogram 3 days after treatment showing disappearance of the hypoechoic tract (arrows). (more ...)
All the ultrasound-guided procedures were carried out using 12–5 mHz or 14–5 mHz linear array transducers and were performed by a single radiologist with 23 years' experience in breast imaging. Rigorous aseptic measures were applied. Local anaesthetic (1–2 ml) was injected at a predetermined site. Ultrasound guidance was used to introduce a 14-gauge needle into the fistulous tract. After catheter placement the fistulous tract was aspirated, a minimum quantity (<1 ml) of purulent-looking material was obtained, and the tract was then irrigated several times with saline solution. Samples of purulent material were sent for microbiological examination. Subsequently, 1 ml of 40 mg ml−1 triamcinolone (Trigon®; Bristol-Myers Squibb, Anagni, Italy) was injected through the catheter (). After withdrawal of the catheter, gentle massage was applied with moderate pressure for a few minutes in order to achieve distribution of the medication. Follow-up clinical and ultrasound examinations were performed at 3 days, 2 weeks and 1, 3, 6 and 12 months.
The response to treatment was assessed as complete (CR) or no response (NR). A successful outcome was regarded as CR when there were no residual symptoms and ultrasound examination showed disappearance of the hypoechoic appearance of the fistulous tract (). NR was considered when there was partial disappearance of the hypoechoic tubular image and the patient continued with suppuration. In those patients with NR, additional ITL was administered at 2-week intervals.