Goodman C M, Cohen V, Thornby J, Netscher D
Division of Plastic Surgery, Baylor College of Medicine, Houston, TX, USA.
Ann Plast Surg. 1998 Dec;41(6):577-85; discussion 585-6. doi: 10.1097/00000637-199812000-00001.
Because of the growing concern surrounding the integrity and life span of silicone gel breast implants and the reported variations in the diagnostic accuracy of various imaging techniques in identifying ruptured implants, the authors undertook a meta-analysis of articles in the scientific literature to examine these concerns. They were able to include reports from the literature that detailed the condition and removal of 1,099 breast implants during the past 7 years. The median life span of a silicone gel implant was estimated to be 16.4 years. Of the implants, 79.1% were intact at 10 years, falling to 48.7% by 15 years. The sensitivities and specificities of three imaging modalities used in the diagnosis of implant rupture (mammography, ultrasonography, and magnetic resonance imaging [MRI]) were also evaluated and compared statistically in an effort to discover which of the three techniques might serve as the most reliable screening tool in the diagnosis of gel implant rupture. The sensitivity of mammography for finding a ruptured implant is 28.4% with a specificity of 92.9%. Ultrasonography has a sensitivity and specificity of 59.0% and 76.8% respectively compared with MRI, which was 78.1% and 80.0% respectively. For implants in place for 10 years, one would need to image 3.3 implants by ultrasound to identify a single possible rupture. However, because of the 76.8% specificity, 8.1 implants would need to be imaged to find a confirmed intraoperative rupture. This was similar to MRI, in which 3.1 implants would need to be imaged to detect one suspected rupture, and 6.1 implants would need to be imaged to find one intraoperatively confirmed rupture. The authors do not recommend either ultrasound or MRI as a screening tool based on their meta-analysis.
由于人们对硅凝胶乳房植入物的完整性和使用寿命日益关注，且有报道称各种成像技术在识别破裂植入物时的诊断准确性存在差异，作者对科学文献中的文章进行了荟萃分析，以研究这些问题。他们纳入了过去7年里详细记录1099例乳房植入物状况及取出情况的文献报告。硅凝胶植入物的中位使用寿命估计为16.4年。在这些植入物中，79.1%在10年时仍完好无损，到15年时降至48.7%。还对用于诊断植入物破裂的三种成像方式（乳房X线摄影、超声检查和磁共振成像[MRI]）的敏感性和特异性进行了评估，并进行了统计学比较，以确定这三种技术中哪一种可能是诊断凝胶植入物破裂最可靠的筛查工具。乳房X线摄影发现破裂植入物的敏感性为28.4%，特异性为92.9%。超声检查的敏感性和特异性分别为59.0%和76.8%，而MRI的敏感性和特异性分别为78.1%和80.0%。对于已植入10年的植入物，通过超声检查识别一个可能破裂的植入物需要对3.3个植入物进行成像。然而，由于特异性为76.8%，要发现一个术中确诊的破裂需要对8.1个植入物进行成像。这与MRI情况类似，检测一个疑似破裂需要对3.1个植入物进行成像，发现一个术中确诊破裂需要对6.1个植入物进行成像。基于荟萃分析，作者不推荐将超声或MRI作为筛查工具。
