Purpose: Two main purposes of a breast implant surgery are a breast enlargement surgery as an elective plastic surgery and a breast reconstructive surgery for a patient who had mastectomy due to a breast cancer. As numbers of patients who have had breast implant surgeries has increased, complications of the surgery have increased as well as difficulty in diagnose of breast related diseases has increased because the breast implants blocks breast. This study was undertaken to discuss the benefits of a breast ultrasound exam to breast implanted patients through comparing a mammography and a breast ultrasound exam, which are primary diagnostic tests of breast related diseases.
Sample and Methods: 115 women, who have had the breast implant surgery in past and have had both mammography and breast ultrasound exam between January 2010 and December 2011 at Samsung Medical Center, were conveniently recruited. Senography DS(GE) was used for mammography , and IU22(Philips) L12-5MHz probe was used for breast ultrasound exams. Breast Imaging-Reporting and Data System (BIRAD), which is a quality assurance tool to standardize reporting and originally published and trademarked by the American College of Radiology (ACR), was used as a method of categorizations. The results of categorization in mammography and breast ultrasound exams were top-down analyzed. Category 1 through category 3 were classified as a same category with positive results, and category 4 and above were also classified as another category with suspected malignant results.
Results: At first, 73 women, who were classified as a category 3 or below for both mammography and breast ultrasound exams, had positive results. Among 8 women with suspected malignant results who were classified as a category 4 or above for both exams, all 5 women who had biopsy after the exams were confirmed with malignant results. Other 3 women among the 8 women did not have biopsy test at Samsung Medical Center because they were confirmed with malignant results at other health care facilities. Second, 4 women, who were classified as a category 3 or below for mammography and as a category 4 or above for breast ultrasound exams, resulted with suspected malignant. Among the 4 women, all 3 women, who had biopsy test or aspiration, were confirmed with positive results. The other 1 woman did not have biopsy test; however, she was classified as a category 2 for mammography and a category 3 for breast ultrasound exam on a 6 months follow-up. Third, 30 women were classified as a category 3 or below with positive results for mammography and as a category 4 or above with suspected malignant results for breast ultrasound exams. Among the 30 women, 25 women had biopsy test, and 24 women were confirmed with malignant result and 1 woman with a positive result. The other 5 women’s results were not identified because they did not have biopsy test or no follow up was done. More results of categorizations for breast ultrasound exams were recorded, which were matched the pathologic outcomes of biopsy test and cytoscopy than the results of categorizations for mammography.
Conclusion: Abreast ultrasound exam is more beneficial than a mammography in detecting significant findings through identifying characteristics of palpated breast mass of breast implanted patients and finding breakage of the implants, which mammography is not able to. The breast ultrasound exam is a less invasive diagnostic test comparing to mammography, which causes much pain to patients, with no danger of radiation exposure. Breast ultrasound exam is less expensive than MRI, which its use has increased as an accessorial diagnostic test of a mammography; therefore, it is a useful screening tool for breast implanted patients. Because it is difficult to expect having 100% accuracy in diagnosis with breast ultrasound exams, a mammography and MRI, which is used for objective evaluation and has a high definition in contrast, should be used with the breast ultrasound exam in case of suspected malignant findings to increase accuracy in diagnosing diseases.
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