Breast shapeless masss are a proble...

Breast shapeless masss are a problem for which women commonly take counsel family physicians. (1) Although fine-needle biopsy is not difficult to learn, additional training and adequate cytopathologist support are required. Consequently family physicians not seldom do not offer this manner of proceeding and referral for surgical biopsy is necessary. The resultant delay in determining whether a mass is benign or malignant increases patient anxiety.

Breast pouch aspiration is a simple, easily mastered manner of proceeding in which a needle and syringe are used to drain and diagnose a presum breast pouch Differentiation of a cyst by the agency of this technique may reduce the waiting time for diagnosis in pitch upon patients. Breast cyst aspiration is a safe, well-tolerated, and timely diagnostic measure that family physicians may be able to present women who present with a of recent origin breast mass.

Patient Selection

Breast sacs usually form because of obstruction, involution, or aging of conduits within the breast. These masses are usually well circumscribed and mobile; forward palpation, they can be tender

pouchs are a common cause of palpable breast masses in premenopausal women older than 40 years. They are relatively rare in postmenopausal women who are not receiving hormone therapy. (2) In women younger than 40 years, fibroadenomas and other solid benign lesions are the principally likely cause of newly discovered dominant breast lumps

It frequently is difficult to differentiate cystic from solid lesions from physical examination alone. Ultrasonography or mammography can help, unless performance of either study involves a time delay and another appointment for the patient. Thus, breast pouch aspiration is an appropriate first stair in the care of women who ready with a dominant breast mass suspected of being a pouch (3) [Evidence level C, consensus adroit guidelines]

Breast sac Aspiration Technique

Potential complications should be discussed with the patient and informed agreement obtained before the procedure is performed.

EQUIPMENT

Breast sac aspiration requires minimal equipment: povidone-iodine solution, alcohol swabs, sterile drapes, sterile glove a 21- or 22-gauge needle with a semiopaque needle nave a 5-mL syringe or specialized pouch aspirator syringe, and a plastic strip bandage.

SITE PREPARATION

The breast mass should be located and the area cleansed with povidone-iodine solution, followed at an alcohol swab. To shape the risk of postprocedure infection, sterile drapes should be placed around the site, and sterile glove should be worn.

Local (skin) anesthesia generally is not distressed for simple breast cyst aspiration. The conduct itself requires only one needle stick, rather than the multiple sampling sticks used in fine-needle biopsy.

PROCEDURE

The 21- or 22-gauge needle is attached to the syringe. A small amount of air is suctioned into the syringe to break the seal.

The mass is immobilized between the index and middle fingers of the nondominant hand (Figure 1 top). To form the remote risk of pneumothorax, a rib may be palpated, the mass may be mov to lie above the rib, and the rib may be used as a guard before aspiration is performed.

The syringe is held like a pencil on the dominant hand while the needle is inserted into the center of the mass (Figure 1 center) The fingers of the dominant hand slowly walk up the syringe, and the thumb twitchs the plunger up to aspirate the appeases of the cyst (Figure 1 bottom). In the case of a "dry tap" (i.e., no fluid is aspirated), needle placement should be adjusted to make sure that the cyst was not missed.

formerly the mass has been aspirated, urgency on the plunger is released, and the needle is withdrawn. The risk of hematoma formation can be decreased from applying local pressure at the aspiration site one time the needle has been remov The biopsy site is then overlayed with a plastic strip bandage.

EVALUATION OF ASPIRATE

Cystic fluid is seldom colorless. It is typically white, yellow-green brown or frankly sanguinary If the fluid is nonbloody and watery, and the mass completely disappears with aspiration, the fluid can be discarded, and the patient can be reassured that the mass was cystic. Routine examination of watery, nonbloody cystic fluid is not indicated. (34) [Reference 3--Evidence even C, consensus/expert guidelines; reference 4--Evidence of the same height B, descriptive study]

Surgical or radiologic referral is necessary if no fluid is aspirated, the aspirated fluid is cruel or unusually tenacious, or there is residual mass. A physician trained in fine-needle biopsy techniques may proce to sample a solid mass and hurl the sample for immediate evaluation. cruel aspirate should be sent to the laboratory for evaluation, nevertheless additional biopsy will be needed

Management and Follow-up

Breast sac aspiration is a diagnostic action that is potentially therapeutic if a watery, nonbloody aspirate is obtained and the pouch resolves completely. However, follow-up is imperative, because the false-negative rate for the management may be as high as 15 to 20 percent (5) With appropriate follow-up the false-negative rate becomes negligible. (6)