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

The objective of this study was to assess the accuracy of magnetic resonance imaging (MRI) in detecting silicone breast implant rupture, and to explore implications of the use of MRI for screening and estimating the prevalence of rupture among asymptomatic women. The study consisted of a meta-analysis 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 predictive value (PPV) and negative predictive value. Participants included women with breast implants who underwent both MRI and subsequent implant removal. Eighteen studies, performed primarily in academic settings, with approximately 1,039 women and 2,036 implants met entry criteria. Most studies involved women with symptomatic implants. Assuming that sensitivity and specificity were independent parameters, the summary sensitivity was 78% (95% confidence interval [CI], 71-83) and the summary specificity was 91% (95% CI, 86-94). Using ROC meta-analysis methodology, the odds ratio describing the overall accuracy of the test was 40.1 (range, 18.8-85.4). There was substantial heterogeneity across studies. Studies using breast coils, those with convenience samples, larger studies, and studies of lower report quality tended to report higher levels of accuracy. The quality of study reports was generally poor. Among symptomatic women, PPV was fairly high. Among lower prevalence populations, PPV appeared to be insufficient to warrant use as a screening tool. MRI is moderately accurate in detecting silicone breast implant rupture. However, MRI should remain a confirmatory diagnostic test and should not be used to screen asymptomatic women.