MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications

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1 MRI evaluation of post-mastectomy irradiated breast implants: prevalence and analysis of complications Poster No.: C-2153 Congress: ECR 2016 Type: Scientific Exhibit Authors: M. Moschetta 1, M. Telegrafo 2, L. Rella 2, A. Nardone 2, A. Milella 2, Keywords: DOI: A. A. Stabile Ianora 2, M. Lioce 2, G. Angelelli 2 ; 1 BARI, IT/IT, 2 Bari/ IT Breast, MR, Radiation therapy / Oncology, Prostheses /ecr2016/C-2153 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 6

2 Aims and objectives To evaluate the effect of post-mastectomy radiation therapy (RT) on breast implants as detected by magnetic resonance imaging (MRI) searching for short-term complications. Methods and materials One hundred and forty patients (total of 144 implants) were evaluated by MRI; 80 (group 1) had undergone RT, whereas the remaining 60 patients (group 2) underwent mastectomy with implant reconstruction without RT. Two radiologists evaluated MRI images searching for implant rupture signs, sub-capsular seromas, capsular contracture, soft-tissue oedema, peri-implant fluid collections. Implant ruptures were classified as severe complications; seromas and capsular contractures as moderate complications; oedema and fluid collections as mild complications. The prevalence of MRI findings in the two groups was calculated and compared by unpaired t-test. Cohen's kappa statistics was used to assess interobserver agreement. Results Sixty-nine out of 144 (48%) implants presented pathological findings at MRI with complication rates of 47.5 and 48.4 for groups 1 and 2, respectively. Two (5%) severe complications (Fig. 1), 10 (26%) moderate complications (Fig. 2), and 26 (69%) mild complications (Fig. 3) occurred in group 1 and surgical treatment was performed in 10 cases. Two (6%) severe complications, seven (23%) moderate complications, and 22 (71%) mild complications occurred in group 2 and surgical treatment was performed in eight cases. No significant difference between the two groups was found (p>0.1). Almost perfect agreement between the two radiologists was found for MRI image detection (k=0.86). Images for this section: Page 2 of 6

3 Fig. 1: STIR (a) and silicone-only (b) MRI images of a 46-year-old patient with an irradiated silicone breast implant showing intra-capsular rupture represented by the "linguine sign". This was considered to be a severe complication in the present series. DEPARTMENT OF RADIOLOGY, UNIVERSITY OF BARI MEDICAL SCHOOL, POLICLINICO BARI - BARI/IT Fig. 2: TSE-T2 (a), STIR (b) and silicone-only (c) MRI images of a 42-year-old patient with an irradiated silicone breast implant showing a large sub-capsular seroma a month after the radiation therapy. This was considered to be a moderate complication in the present series. DEPARTMENT OF RADIOLOGY, UNIVERSITY OF BARI MEDICAL SCHOOL, POLICLINICO BARI - BARI/IT Page 3 of 6

4 Fig. 3: STIR (a) and TSE-T2 (b) MRI images of a 48-year-old patient with an irradiated silicone breast implant showing peri-implant soft-tissue oedema (arrows) 2 months after the radiation therapy. This was considered to be a mild complication in the present series. DEPARTMENT OF RADIOLOGY, UNIVERSITY OF BARI MEDICAL SCHOOL, POLICLINICO BARI - BARI/IT Page 4 of 6

5 Conclusion RT does not seem to cause a significant effect on breast implants in terms of complication rate in patients undergoing implant-based breast reconstruction. One-stage immediate implant-based breast reconstruction performed at the same time as mastectomy could be proposed. Personal information Prof Marco Moschetta DIM - Section of Diagnostic Imaging University of Bari Medical School Bari - Italy marco.moschetta@gmail.com References 1. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366:2087e Eriksson M, Anveden L, Celebioglu F, et al. Radiotherapy in implantbased immediate breast reconstruction: risk factors, surgical outcomes, and patient-reported outcome measures in a large Swedish multicenter cohort. Breast Cancer Res Treat 2013;142:591e Hirsch EM, Seth AK, Dumanian GA, et al. Outcomes of tissue expander/implant breast reconstruction in the setting of prereconstruction radiation. Plast Reconstr Surg 2012;129:354e Barry M, Kell MR. Radiotherapy and breast reconstruction: a metaanalysis. Breast Cancer Res Treat 2011;127:15e Berry T, Brooks S, Sydow N, et al. Complication rates of radiation on tissue expander and autologous tissue breast reconstruction. Ann Surg Page 5 of 6

6 Oncol 2010;17(Suppl. 3):202e Kronowitz SJ, Robb GL. Radiation therapy and breast reconstruction: a critical review of the literature. Plast Reconstr Surg 2009;124:395e Ho A, Cordeiro P, Disa J, et al. Long-term outcomes in breast cancer patients undergoing immediate 2-stage expander/implant reconstruction and postmastectomy radiation. Cancer 2012;118:2552e9. dx.doi.org/ / cncr Theriault RL, Carlson RW, Allred C, et al. Breast cancer, version : featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2013;11:753e Moschetta M, Telegrafo M, Capuano G, et al. Intra-prosthetic breast MR virtual navigation: a preliminary study for a new evaluation of silicone breast implants. Magn Reson Imaging 2013;31:1292e Juanpere S, Perez E, Huc O, et al. Imaging of breast implants-a pictorial review. Insights Imaging 2011;2:653e70. Page 6 of 6