Ana Maria Fernandez Martinez MD, Presenter: Nothing to Disclose

Laura Lopez, Abstract Co-Author: Nothing to Disclose

Iria Alvarez Silva, Abstract Co-Author: Nothing to Disclose

Jose Daniel Samper Wamba MD, Abstract Co-Author: Nothing to Disclose

Teresa Cuesta, Abstract Co-Author: Nothing to Disclose

Breast fistulas are defined as communication between one or more ducts and the skin. The disease affects young women and it is an insidious clinical pathology, usually with long evolution and with a major impact on daily life. The treatment has traditionally been surgical with a high rate of recurrence. We propose to study the clinical utility of ultrasound-guided sclerosis with alcohol as an alternative treatment to surgery in breast fistulas.  

A retrospective study based on data collected during 3 years, from January 2011 to December 2013. All breast fistulas diagnosed and treated with ultrasound-guided sclerosis with alcohol were reviewed. The technique of ultrasound-guided sclerosis with alcohol consists of introducing a solution of pure alcohol reduced to 50% with an anesthetic agent. The result of the percutaneous treatment was recorded as bad (partial response, secretion persists), good (partial response, low discharge) or excellent (complete response, absence of secretion, complete closure).

Ten fistulas were identified in nine women. The median age was 35 years old (interquartile range was 18.5 years). The median time for the clinical evolution of the disease was 24 months. In five patients, fistulas were caused by recurrent mastitis (50%), in four patients fistulas were attributed to previous surgery (40%) and in one case to breastfeeding (10%). Patients reported clinical exacerbation in winter (78%), symptoms associated with menstruation (33%) and symptoms associated with stressful situations (22%). Nipple inversion existed in 45% of the patients. 78% of patients were smokers. No immediate complications were noted. The procedure was well tolerated in most cases (9 out of 10 patients scored 1 or 2 on the visual analogue scale of pain). During the follow-up time there has not been evidence of recurrence in any of them. The response to the treatment was excellent in eight fistulas (80%) and good in two of them (20%).

Ultrasound-guided sclerosis with alcohol is a therapeutic alternative to surgery that shows favorable clinical results in the treatment of breast fistulas.

The biggest problem of fistulas breast is the high rate of recurrence after surgical treatment. We propose a new treatment, less aggressive, with favorable clinical results as a therapeutic alternative.    

Fernandez Martinez, A, Lopez, L, Alvarez Silva, I, Samper Wamba, J, Cuesta, T, Almost a Wonder: Ultrasound-guided Sclerosis with Alcohol in Breast Fistulas; A New Treatment.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14001934.html