Imaging methods to screen women with breast implants

Method

Literature search of three modalities to include mammography, ultrasound and magnetic resonance imaging (MRI).

Following the report of the Independent Review Group in 1998, in Britain silicone gel breast implants have not been proven unsafe. There are currently 100 000 women in the UK with implants (Park et al. 1998). Women aged 50-64 years who fall into this category are invited for routine mammographic screening, thereby presenting a technical challenge to the screening mammographer who often has no information about the surgical placing of the implant or the degree of capsular contracture (if present). In this paper, an evaluation was made, comparing mammography, ultrasound and MRI, to screen such women. Each modality was studied in turn and benefits and disadvantages noted.

Conclusion

To screen well women, mammography was found to be the optimum basic imaging method to visualise breast parenchyma. However, this must be performed by a skilled mammographer who can tailor the examination accordingly and use the appropriate technique (eg Eklund views).

Ultrasound proved a useful addition to mammography in evaluating asymmetric densities following augmentation, but the sensitivity was lower than mammography (Azavedo and Bone 1999). The role of MRI in breast cancer diagnosis remains investigational, requiring an intravenous contrast to show tumour enhancement. MRI is, however, an excellent tool to question implant integrity.

Paper submitted for Post Graduate Certificate in Mammography.