The effectiveness of needle aspiration versus traditional incision and drainage in the treatment of breast abscess: a meta-analysis

Background Breast abscess is a common and intractable clinical condition and the use of needle aspiration (NA) or incision and drainage (ID) in treatment is controversial. This meta-analysis aimed to systematically compare the clinical effectiveness of NA and ID in treating breast abscesses. Methods The Web of Science, ScienceDirect, PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang Data were searched for randomized controlled trials (RCTs) published from inception to January 7, 2022. The ROB-2 tool assessed risk of bias; the GRADE methodology rated certainty in outcomes; and Stata 16.0 performed data analyses. Results Nine RCTs were included, including 703 patients. The results showed there was no significant difference in cure rate between the two groups (relative risk [RR] = 0.96, 95% confidence interval [CI] [0.86, 1.07]; p = .469), and after subgroup analysis, we found that it was not related to the use of ultrasound guidance or not. There was no significant difference in the recurrence rate (RR = 0.68, 95% CI [0.35, 1.30]; p = .241). Furthermore, the NA group was associated with shorter healing time (weighted mean differences = -11.02, 95% CI [-15.14, -6.90]; p < .001), lower incidence of breast fistula (RR = 0.21, 95% CI [0.06, 0.72]; p = .013), lower interrupted breastfeeding rate (RR = 0.28, 95% CI [0.20, 0.39]; p < .001), and higher satisfaction rate of appearance (RR = 1.51, 95% CI [1.03-2.21]; p = .035). Conclusion NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction. Although NA and ID have similar cure and recurrence rates, NA, with or without ultrasound guidance, could be used as a first-line treatment for breast abscesses. Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID. KEY MESSAGES Breast abscess is a common and intractable clinical condition in general surgery. Compared with ID for breast abscesses, NA has better advantages in terms of healing time, avoidance of breast fistula, continuous breastfeeding, and patient satisfaction and could be used as a first-line treatment for breast abscesses. Patients with large volumes, multicompartmental abscesses, or those who have been ineffective against multiple NA, should be considered for ID.