MRI to evaluate breast implants – pro
Lay Summary: MRI is indicated to evaluate possible breast implant rupture.
Women who have had previous surgery for breast cancer, have silicone or saline implants, or have radiographically dense breasts may have inconclusive results from clinical examination, mammography, and ultrasound. When these methods of evaluation are inconclusive, the radiologist may recommend an MRI if it is likely to provide more diagnostic information. Breast MRI can often distinguish between scar tissue and recurrent cancer and its image quality is not significantly impaired by dense tissue or implants. If a clinical suspicion of silicone implant rupture exists, breast MRI is the most accurate test for evaluation. FDA, in its silicone implant approval, recommends magnetic resonance imaging (MRI) as the current method of choice for detecting silent rupture of silicone gel-filled breast implants. Now that silicone implants have become rare, the same considerations and reasoning should apply to other kinds of implants and this is how most insurers proceed. Their policies do not differentiate between silicone and saline implants. For example, BCBS policy says that breast MRI is medically necessary: “To evaluate the integrity of non-cosmetically placed breast implants and detecting rupture in symptomatic patients who are suspected of having a breast implant
rupture.” There are no guidelines that recommend annual MRI screening in this situation. Yearly physical exams and monthly self-exams are considered sufficient, with imaging being done only if something unusual is found.
ACR says: “ Breast MRI using contrast may be indicated in the evaluation of patients with silicone or saline implants and/or free injections with silicone, paraffin, or polyacrylamide gel in whom mammography is difficult. The integrity of silicone implants can be determined by noncontrast MRI. “
http://www.fda.gov/cdrh/ode/guidance/1239.html
http://www.acr.org/secondarymainmenucategories/quality_safety/guidelines/breast/mri_breast.aspx
Hölmich, L.R., et al. 2005b. The diagnosis of breast implant rupture: MRI findings compared to findings at explanation. 2005. Eur J. Radiol. 53: 213-25.
R. M. Mann et al, Breast MRI: guidelines from the European Society of Breast Imaging
Eur Radiol. 2008 July; 18(7): 1307–1318.
FDA Update on the Safety of Silicone Gel-Filled Breast Implants (2011) – Executive Summary. Update on the Safety of Silicone Gel-Filled Breast Implants (2011) – Executive Summary
ACR Expert Panel on Breast Imaging: Ana P. Lourenco, MD et al.Appropriateness Criteria Breast Implant Evaluation J Am Coll Radiol 2018;15:S13-S25.