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A New, Simple Method to Describe Magnetic Resonance Imaging of Silicone Breast Implants

2013; Lippincott Williams & Wilkins; Volume: 132; Issue: 6 Linguagem: Inglês

10.1097/prs.0b013e3182a9807d

1529-4242

Maria C. Maijers, Frank B. Niessen, Jacob F. H. Veldhuizen, Marco J.P.F. Ritt, Radu A. Manoliu,

Digital Radiography and Breast Imaging

Sir: We would like to share with colleagues a newly designed method to record radiologist’s magnetic resonance imaging findings on silicone breast implant condition in two categories, to avoid subjective interpretation of inconclusive text, called Silicone Implants Reporting and Data System (SI-RADS). We designed this tool to re-evaluate magnetic resonance images in our ongoing studies of women previously implanted with Poly Implant Prothèse implants. Magnetic resonance imaging silicone breast implant screening studies have been criticized for not using a uniform terminology on implant condition or status. We also found a somewhat disappointing accuracy of magnetic resonance imaging screening in asymptomatic women with Poly Implant Prothèse breast implants1 when compared with a recent magnetic resonance imaging validation study.2 Validation studies, however, use multiple radiologists who are assigned to the sole task of evaluating the images for research purposes, which improves sensitivity and specificity but is not often applicable to common daily practice. In our daily clinical practice, we noticed a broad spectrum of terminology used by individual radiologists to describe implant condition. Terms such as “leaking” and “fluid seen” or “released” provided by radiologists are left to plastic surgeons to interpret as implants being ruptured or not. The decision to advise explantation is often based on these, at times not conclusive, magnetic resonance imaging reports. Unlike the diagnosis of a bone fracture, the radiologic diagnosis of a ruptured implant is subject to different degrees of confidence of the reporting radiologist. In breast cancer, one has an identical problem regarding the confidence in the interpretation of the radiologic findings in individual patients. The Breast Imaging Reporting and Data System (BI-RADS) was developed and introduced by the American College of Radiology to solve this problem and to provide a clear and simple radiologic describing system; it improved communication between physicians and can be used in the daily practice of decision making by the oncologic surgeon.3,4 This Breast Imaging Reporting and Data System methodology has been used successfully in the Dutch national breast cancer screening program for many years.5 Why not use an analogous system to screen silicone breast implant condition? The simple and structured Silicone Implants Reporting and Data System tool was developed with two categories: (A) implant status and (B) signs of extracapsular silicone leakage. The multiple-choice answers as a measure of confidence, inspired by the breast imaging system’s methodology, left no room for inconclusive or descriptive text (Table 1). The Silicone Implants Reporting and Data System methodology was then applied to re-evaluate the 2-year-old magnetic resonance images of 214 implants completed by two of the three original radiologists. The radiologists found the silicone implants tool easy to use and time sparing. An example of a clearly ruptured and partially collapsed silicone implant in the left breast is shown in Figures 1 and 2. We compared the magnetic resonance imaging reports with the explantation results and found an improved sensitivity and specificity of from 80 and 91 percent to 93 and 93 percent, respectively, of magnetic resonance imaging screening in asymptomatic women with Poly Implant Prothèse breast implants when using the silicone implants tool, compared with the previous magnetic resonance imaging reporting. We would advise colleagues to implement this new Silicone Implants Reporting and Data System (SI-RADS) methodology of simple, uncomplicated, and uniform reporting of silicone implants in their daily practices, as we believe this would improve communication between radiologists and plastic surgeons.Table 1: Silicone Implant Reporting and Data SystemFig. 1: Water-suppressed STIR-T2–weighted axial image of both breasts shows infolding of an intact implant in the right breast. Shell rupture and partial collapse of the implant in the left breast can also be seen. This was SI-RADS classified as Left: A4B1 and Right: A1B1.Fig. 2: View of the ruptured implant in the left breast on a sagittal water-suppressed STIR-T2–weighted image.DISCLOSURE The authors have no financial interest to declare in relation to the content of this article. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Maria C. Maijers, M.D. Department of Plastic and Reconstructive and Hand Surgery VU University Medical Center Franciscus B. Niessen, M.D., Ph.D. Department of Plastic and Reconstructive and Hand Surgery VU University Medical Center, and Medical Center Jan van Goyen Jacob F. H. Veldhuizen, M.D. MRI Center Amsterdam Marco J. P. F. Ritt, M.D., Ph.D. Department of Plastic and Reconstructive and Hand Surgery VU University Medical Center Radu A. Manoliu, M.D., Ph.D. MRI Center Amsterdam Amsterdam, The Netherlands