FRAMARIN A, GELINAS H; International Society of Technology Assessment in Health Care. Meeting.
Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2001; 17: abstract no. 86.
Agency for Health Services and Technology Assessment (AETMIS), 2021, Union Avenue, bureau 1040, Montreal (Quebec) Canada, H3A 2S9
Objective - To assess the effectiveness of mammography for the diagnosis of silicone breast implant rupture and to determine whether its effectiveness and the associated risks justify the utilisation of ultrasound or MRI.Methods - We reviewed evaluation reports published by ANDEM (1996), the Independent Review Group from UK (1998) and the Institute of Medicine (IOM) (2000). The IOM report is the most recent and includes the literature published up to 1998. Our review was completed by a computerised search in the Medline, HEALTHSTAR, EMBASE and the Cochrane Library databases since 1998 up to July, 2000. We also reviewed the recommendations of professional associations and governmental groups. The search was completed by hand searching of recent journals.Results - Implant rupture is defined as the presence of silicone gel outside the implant and/or the capsular surface. Explantation and visual examination of the implant surface was the standard used to assess performance of the diagnostic method in each of the 25 case series reviewed. Eight studies compared parallel testing with two or three diagnostic methods. Mammography is a rapid and inexpensive exam with greater sensitivity to detect extracapsular rupture but is of limited use for intracapsular rupture. Its specificity is good (82-100%). The iatrogenic rupture of implants due to breast compression during mammography seems uncommon. Sensitivity and specificity of ultrasound present a wide variation (sensitivity 25%-74%; specificity 50%-96%) probably because it is highly operator-dependent. MRI is both sensitive (46%-100%) and specific (55%-100%) although the higher level of sensitivity is related to better diagnosis of intracapsular rupture.Conclusion - There is no evidence to justify a screening program to detect breast implant rupture nor to establish a serial diagnostic protocol. Each imaging technique has limitations. Mammography and ultrasound may provide good clinical information. The performance of MRI appears superior but could cause unnecessary explantation. Available information is therefore insufficient to determine which is the best method.
Publication Types:
Keywords:
- Breast
- Breast Diseases
- Breast Implantation
- Breast Implants
- Case-Control Studies
- Evaluation Studies
- Magnetic Resonance Imaging
- Mammography
- Prostheses and Implants
- Reproducibility of Results
- Rupture
- Sensitivity and Specificity
- Silicone Gels
- Silicones
- United States
- diagnosis
- methods
- radiography
- surgery
- ultrasonography
- hsrmtgs
Other ID:
UI: 102274418
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