MRI for detecting silicone breast implant rupture: Meta-analysis and implications

The objective of this study was to assess the accuracy of magnetic resonanc e imaging (MRI) in detecting silicone breast implant rupture, and to explor e implications of the use of MR[ for screening and estimating the prevalenc e of rupture among asymptomatic women. The study consisted of a meta-analys is of published studies with the calculation of sensitivity and specificity as independent parameters, the summary receiver operating characteristic ( ROC) curve, and other clinically important values such as positive predicti ve value (PPV) and negative predictive value. Participants included women w ith breast implants who underwent both MRI and subsequent implant removal. Eighteen studies, performed primarily in academic settings, with approximat ely 1,039 women and 2,036 implants met entry criteria. Most studies involve d women with symptomatic implants. Assuming that sensitivity and specificit y were independent parameters, the summary sensitivity was 78% (95% confide nce interval [CI], 71-83) and the summary specificity was 91% (95% Cl, 86-9 4). Using ROC meta-analysis methodology, the odds ratio describing the over all accuracy of the test was 40.1 (range, 18.8-85.4). There was substantial heterogeneity across studies. Studies using breast coils, those with conve nience samples, larger studies, and studies of lower report quality tended to report higher levels of accuracy. The quality of study reports was gener ally poor. Among symptomatic women, PPV was fairly high. Among lower preval ence populations, PPV appeared to be insufficient to warrant use as a scree ning tool. MRI is moderately accurate in detecting silicone breast implant rupture. However, MRI should remain a confirmatory diagnostic test and shou ld not be used to screen asymptomatic women.