Silicone Induced Granuloma of Breast Implant Capsule (SIGBIC) diagnosis: Breast Magnetic Resonance (BMR) ability to detect silicone bleeding

Abstract

ABSTRACTObjectiveTo evaluate the ability of BMRI to detect silicone gel bleeding in a prospective observational study including consecutive patients referred for BMRI scan. Methods: From January 2017 to March 2018, patients referred for BMRI were evaluated in a prospective observational study. Patients who had breast implants were included. BMRI recorded 9 findings according to BI-RADS lexicon and SIGBIC findings, considered equivocal features to detect gel bleeding (GB). Three new original imaging features were added for SIGBIC diagnosis: black drop signal; T2* hypersignal mass; and delayed contrast enhancement, considered as irrevocable signs. The presence of silicone corpuscle was confirmed by percutaneous biopsy or surgical capsulectomy. Accuracy of BMRI SIGBIC findings to predict GB was determined. We also used univariate analysis for the equivocal features for GB diagnosis. The Backward method was applied for a multivariate Logistic Regression model for the equivocal features. Results: SIGBIC was diagnosed in 208 patients and GB was histologically confirmed in all cases. No false positive results were observed. The most important imaging equivocal feature associated with GB was capsular contracture. In order of prevalence, the main equivocal BMRI features associated to GB with statistically significance (P < =0.001) were as follows: 1.water droplets (OR=2.8; 95%CI 1.8-4.4); 2.enlarged intramammary lymph node (OR=3.1; 95%CI 1.5-6.1); 3.pericapsular edema (OR=5.0; 95%CI 2.3-11.1); and 4.intracapsular seroma (OR=2.4; 95%CI 1.4-4.1).ConclusionSIGBIC diagnosis has high sensitivity to predict GB by the 3 irrevocable BMRI features described by the authors. We suppose GB is underdiagnosed in clinical practice by BI-RADS features.