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Researchers Recommend MRI as Best Tool for Evaluating Breast Implant Ruptures: Presented at ASBD

By Arushi Sinha

SAN FRANCISCO, CA -- April 18, 2007 -- Clinical examination along with breast magnetic resonance imaging (MRI) appear to be an accurate approach to identifying women with breast implant rupture.

Current methods for clinically evaluating breast implant rupture include physical examination, mammogram, ultrasound, and MRI, researchers said here at the 31^st Annual Symposium of the American Society of Breast Disease (ASBD).

A study by Karen Barbosa, MD, surgeon, department of general surgery, Breast Center, Cleveland Clinic, Cleveland, Ohio, United States, and colleagues compared the efficacy of all of these diagnostic methods.

With the growing prevalence of elective and reconstructive cosmetic breast surgery, an accurate evaluation of implant status is important to differentiate an implant leak from a potential tumour.

"We posed the question: "Is it a rupture or is it a new cancer?'" Dr. Barbosa said

In order to help answer this question, 84 patients were selected to undergo breast MRI for evaluation of implant status. The breast MRI was performed using dedicated breast coil at 1.0 Tesla and a standard implant evaluation protocol: coronal, axial, and sagittal short tau inversion recovery sequences with water-suppressed axial imaging. No contrast material was administered.

Of this sample, 33 patients had mammograms prior to undergoing breast MRI and 14 had ultrasound prior to breast MRI. In addition, 19 (23%) patients underwent intraoperative explantation of their implant. The purpose of this part of the process was to compare the validity of ultrasound, mammography and breast MRI.

Following intraoperative explantation of the breast implants, it was found that 13 (68%) patients whose breast MRI indicated implant rupture were confirmed intraoperatively, and 6 (32%) who had breast MRI that indicated an intact implant(s), were also confirmed intraoperatively.

By contrast, in the case of the ultrasound, there were 2 false negatives in the ultrasound screening that were later confirmed as rupture upon intraoperative evaluation. The mammograms also reported 4 instances of intact implants, which were shown to be ruptured by surgical explantation.

Therefore ultrasound and mammography combined resulted in 6 cases of missed ruptures, or a 32% false negative rate.

Based upon their experience the researchers concluded that clinical examination along with a breast MRI is a reasonable and accurate approach for most patients.

"In our study, in each case, the intraoperative examination confirmed the findings of the breast MRI," explained Dr. Barbosa.


[Presentation title: Evaluation of bMRI, Mammogram and Ultrasound Compared to Intraoperative Findings When Trying to Rule out Implant Rupture. Abstract F-4]

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