ACR Guidelines Updated for Radiologists Evaluating Breast Implants

In Nov. 2023, the Journal of the American College of Radiology (JACR) published updated guidance on the appropriate initial imaging for both asymptomatic and symptomatic patients with breast implants. Variant 13 of the ACR Appropriateness Criteria® Breast Implant Evaluation: 2023 Update specifically addresses imaging guidelines for patients who have symptoms of BIA-ALCL.

The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions. Each year, a multidisciplinary expert panel provides a systematic analysis of peer-reviewed medical journals for an annual update.

The 2023 update to the appropriate initial imaging in both asymptomatic and symptomatic patients with breast implants includes the following information:

• For asymptomatic patients with saline implants, no imaging is recommended. If concern for rupture exists, ultrasound is usually appropriate, though saline rupture is often clinically evident.

• The FDA recently recommended patients have an initial ultrasound or MRI examination 5 to 6 years after initial silicone implant surgery and then every 2 to 3 years thereafter.

• In a patient with unexplained axillary adenopathy with current or prior silicone breast implants, ultrasound and/or mammography are usually appropriate, depending on age.

• In a patient with concern for silicone implant rupture, ultrasound or MRI without contrast is usually appropriate.

• In the setting of a patient with breast implants and possible implant-associated anaplastic large cell lymphoma (BIA-ALCL), ultrasound is usually appropriate as the initial imaging.