From the Guidelines
The best test to evaluate a breast mass in a patient with breast implants is Ultrasound (US) breast, as it is usually appropriate for initial imaging in patients with clinical evaluation equivocal for implant rupture, particularly in those younger than 40 years of age 1. When evaluating a breast mass in a patient with breast implants, the primary concern is to accurately diagnose the nature of the mass while considering the presence of the implant.
- The American College of Radiology recommends US breast as the initial imaging modality for patients with saline breast implants and clinical evaluation equivocal for implant rupture, especially in those under 40 years old 1.
- US will frequently identify a fluid collection or mass if present and provides image guidance for diagnostic aspiration of the fluid for cytology or core biopsy of a mass lesion 1.
- In cases where a mass is present, US can characterize it as an oval, hypoechoic, and well-circumscribed solid mass, without hypervascularity, although complex-cystic masses have also been observed 1.
- The sensitivity of US for detecting masses in patients with breast implants is reported to be 84% by Adrada et al 1.
- While Diagnostic DBT and diagnostic mammography may be appropriate for initial imaging in patients 40 years or older with saline breast implants and clinical evaluation equivocal for implant rupture, US remains a valuable initial tool due to its accessibility and ability to guide further diagnostic procedures 1.
From the Research
Evaluation of Breast Mass in Patients with Breast Implants
- The best test to evaluate a breast mass in a patient with breast implants is a topic of interest in the medical field, with various studies suggesting different approaches 2, 3, 4, 5, 6.
- According to a study published in 2021, breast magnetic resonance imaging (MRI) has been superior in the characterization and detection of breast cancer, especially in patients with invasive features, compared to traditional imaging techniques such as mammography and ultrasound 2.
- Another study from 2012 found that breast MRI can be useful in evaluating palpable breast masses with negative diagnostic mammogram and ultrasound studies, with a sensitivity of 100% and specificity of 70% 3.
- A review published in 2022 compared the diagnostic performance of MRI, ultrasound, and mammography for detection of breast cancer, and found that MRI provided the highest sensitivity, while mammography had the lowest sensitivity regardless of breast type, density, and history 4.
- In terms of specific guidelines, the American College of Radiology (ACR) recommends that women with clinically detected breast masses undergo evaluation with ultrasound, and that diagnostic mammography is the initial imaging modality of choice for women aged ≥ 40 years 6.
- For patients with breast implants, MRI may be a useful tool in evaluating breast masses, as it can provide detailed images of the breast tissue and help detect any abnormalities 2, 4.
- However, it's worth noting that the use of MRI for evaluating breast masses is not without limitations, and the results should be interpreted in conjunction with clinical findings and other imaging modalities 3, 6.