A recent review questions the diagnostic value of screening magnetic resonance imaging (MRI) scans in women with silicone implants.

The US Food and Drug Administration (FDA) currently recommends regular follow-up MRI scans for women with silicone breast implants. But a new review revealed significant flaws in the evidence supporting this recommendation, according to new findings.

The study's results were reported the March 2011 issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). Because of these scientific limitations, the available data may overestimate the ability of MRI to detect ruptured breast implants--particularly when scans are performed for screening reasons in symptom-free women. The study was led by Dr. Jae W. Song of the University of Michigan (Ann Arbor, USA).

The researchers reviewed 21 studies evaluating MRI and/or ultrasound to identify rupture of silicone breast implants. Although the FDA recommends MRI scanning, some physicians prefer ultrasound for screening purposes. The combined data suggested that MRI was fairly accurate in detecting implant-related problems. However, it was much more likely to detect problems in women with implant-related symptoms: 14 times more likely than in women without symptoms. Even in a mixed "screening sample”--consisting of some women with and some without symptoms--the detection rate was twice as high as in asymptomatic women.

Because most of the women studied had symptoms, the true accuracy of MRI for detecting implant-related problems in asymptomatic women was probably much lower. For ultrasound, reported accuracy rates varied widely.

Silicone breasts implants have been extensively evaluated because to concerns about possible adverse health effects. Based on reports tying ruptured implants to autoimmune diseases, the FDA banned silicone implants in 1992. The ban was lifted in 2006, when repeated studies could not validate the association with autoimmune diseases. However, the FDA recommended that women undergo regular MRI scans in the years after surgery to screen for implant rupture. Given that more than 1.25 million women in the United States have received silicone implants, it is important to evaluate the evidence that MRI is an effective screening test.

The study raises important questions about the accuracy of MRI scanning, particularly in women without symptoms. Beyond the issue of accuracy, the investigators noted that screening tests are typically performed to detect diseases with serious consequences--whereas the health risks associated with ruptured silicone implants, if any, are still unknown.

The researchers also noted that in reported cases of implant rupture, the average age of the implants is over 10 years. Dr. Song and coauthors wrote in their article, "[T]he benefits of screening within the first 10 years are unclear, and the effectiveness of such a screening program warrants further investigation.”

More studies are also needed, according to the researchers, to evaluate the long-term health effects of ruptured silicone breast implants, the effectiveness of MRI or other screening tests, and the costs of and patient preferences for screening.

 

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