Kcr2018 poster
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Clinical Application of Elastography in Prediction of Silicone Implant Rupture Tony W Chi, MD MBA Nagashima Breast Imaging Center, NBIC Clinic, Taiwan Summary The negative predictive value of type I and positive predictive value of type III of real-time elastography are probably high enough to improve the breast ultrasound ability for the diagnosis of silicone implant rupture. The potential of the combination of ultrasound and elastography may be a new standard for the silicone implant surveillance.
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Kcr2018 poster
- 2. ⦿ Elastography, a real-time ultrasound technique to map relative elasticity of the tissue, may be an acceptable method to evaluate breast silicone implants rupture with high negative predictive value and safety guarantee as well.
- 3. ⦿ 85 women, 169 silicone implants examined by elastrography (2015.04.01-2017.05.30) ⦿ The elastographic results were divided into three types: › I. "red-green-blue layering" pattern (n=147) › II. "layering defect" pattern (n=11) › III. "non-layering" pattern (n=11) ⦿ (type I suggesting intact, type II suggesting questioned, type III suggesting rupture)
- 7. ⦿ Negative finding (n=73 women) › type I "layering" pattern in 147 silicone implants (147/169) › double confirmed with ultrasound finding of homogenous anechoic interior. No additional study was needed. ⦿ Positive finding (n=12 women) › type II "layering defect" pattern in 11 silicone implants (11/169) ●intact (7/11) ●rupture (4/11)(ppv=36%) › type III "nonlayering" pattern in 11 silicone implants (11/169) ●intact (1/11) ●rupture (10/11)(ppv=90%) › all confirmed by surgery, MRI or typical ultrasound finding (extracapsular rupture).
- 8. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 35 9 type II intact ruptured - Right 9 type III ruptured ruptured -
- 9. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 27 1 type III ruptured ruptured - Right 1 type II intact intact -
- 10. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 26 1 type II intact intact - Right 1 type III ruptured ruptured -
- 11. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 33 1 type III ruptured ruptured - Right 1 type III intact intact -
- 12. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 51 19 type III ruptured ruptured - Right type III ruptured ruptured -
- 13. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 40 10 type III ruptured ruptured - Right 10 type III ruptured ruptured -
- 14. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 44 7 type II intact intact - Right
- 15. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 36 5 type I intact - intact Right 5 type II intact - intact
- 16. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 38 2 type II intact - intact Right 2 type II intact - intact
- 17. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 28 5 type II ruptured* loss F/U - Right 5 type II ruptured* loss F/U - *typical extracapsular rupture
- 18. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 47 4 type II intact loss F/U - Right 4 type III ruptured* loss F/U - *typical extracapsular rupture
- 19. Age (Yr) Implant (Yr) Elastrogram Ultrasound Surgery MRI Left 70 40 type III ruptured* loss F/U - Right 40 type II ruptured* loss F/U - *typical extracapsular rupture
- 20. ⦿ The negative predictive value of type I and positive predictive value of type III of real-time elastography are probably high enough to improve the breast ultrasound ability for the diagnosis of silicone implant rupture. ⦿ The potential of the combination of ultrasound and elastography may be a new standard for the silicone implant surveillance.
- 22. Q & A
Editor's Notes
- This study included 28 implants in 16 patients, all of whom underwent ABVS in between 2010-2014. The diagnosis of implant rupture was confirmed by surgery. Implant rupture was diagnosed in 5 out of 28 implants (17.9%). In those patients with ruptured implants, 2 were belonging to deflation of saline implants and 3 were silicone implants. 3 had no symptoms, 1 presented with pain, and 1 complained of ipsilateral axillary lymph node swelling. Implants with a homogenous anechoic interior were considered to be intact. ABVS findings indicating implant rupture included multiple parallel echogenic lines in the implant interior in 2 cases and a mix of hyperechoic and hypoechoic masses in 3 cases.
- Cosmetic breast augmentation is an increasingly common procedure performed in Taiwan. Breast prosthesis implantation is still the most common technique. The exact incidence of breast implant rupture is unknown, although the risk of rupture is directly related to the age of the implant and is inversely related to the thickness of the elastomer shell. *(Brown SL, Middleton MS, Berg WA, Soo MS, Pennello G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR 2000; 175:1057-1064)
- Most of the women with breast augmentation do not have a right concept about the routine breast examination and the rupture risk of the breast prosthesis. Some of them are afraid of the compression technique of mammography. Breast MRI, standard technique to detect implant rupture, may be too expensive for them. Automated breast volume scanner (ABVS, Siemens) may be better used to replace breast MRI as a yearly screening tool not only early detection of breast cancer but also the possibility of implant rupture.
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)
- Implant rupture as a late complication of breast implant surgery is often a silent phenomenon that is difficult to diagnose. Ultrasound detects silicone implant rupture with a sensitivity of 50-77% and specificity of 55-84%. (Venta LA, Salomon CG, Flisak ME, Venta ER, Izquierdo R, Angelats J. Sonographic signs of breast implant rupture. AJR 1996; 166:1413-1419)