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Vittorietti M, Mazzola S, Costantino C, De Bella DD, Fruscione S, Bonaccorso N, Sciortino M, Costanza D, Belluzzo M, Savatteri A, Tramuto F, Contiero P, Tagliabue G, Immordino P, Vitale F, Di Napoli A, Mazzucco W. Implant replacement and anaplastic large cell lymphoma associated with breast implants: a quantitative analysis. Front Oncol 2023; 13:1202733. [PMID: 37927474 PMCID: PMC10622658 DOI: 10.3389/fonc.2023.1202733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/28/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare form of non-Hodgkin T-cell lymphoma associated with breast reconstruction post-mastectomy or cosmetic-additive mammoplasty. The increasing use of implants for cosmetic purposes is expected to lead to an increase in BIA-ALCL cases. This study investigated the main characteristics of the disease and the factors predicting BIA-ALCL onset in patients with and without an implant replacement. Methods A quantitative analysis was performed by two independent researchers on cases extracted from 52 primary studies (case report, case series, and systematic review) published until April 2022 and searched in PubMed, Scopus, and Google-Scholar databases using "Breast-Implant" AND/OR "Associated" AND/OR "Anaplastic-Large-Cell-Lymphoma". The statistical significance was verified by Student's t-test for continuous variables, while Fisher's exact test was applied for qualitative variables. Cox model with time-dependent covariates was used to estimate BIA-ALCL's onset time. The Kaplan-Meier model allowed the estimation of the probability of survival after therapy according to breast implant exposure time. Results Overall, 232 patients with BIA-ALCL were extracted. The mean age at diagnosis was 55 years old, with a mean time to disease onset from the first implant of 10.3 years. The hazard of developing BIA-ALCL in a shorter time resulted significantly higher for patients not having an implant replacement (hazard ratio = 0.03; 95%CI: 0.005-0.19; p-value < 0.01). Patients with implant replacement were significantly older than patients without previous replacement at diagnosis, having a median time to diagnosis since the first implant of 13 years (7 years in patients without replacement); anyway, the median time to BIA-ALCL occurrence since the last implantation was equal to 5 years. Discussion Our findings suggest that, in BIA-ALCL patients, the implant substitution and/or capsulectomy may delay the disease's onset. However, the risk of reoccurrence in an earlier time should be considered in these patients. Moreover, the time to BIA-ALCL onset slightly increased with age. Selection bias, lack of awareness, misdiagnosis, and limited data availability could be identified as limits of our study. An implant replacement should be considered according to a risk stratification approach to delay the BIA-ALCL occurrence in asymptomatic patients, although a stricter follow-up after the implant substitution should be recommended. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO, identifier: CRD42023446726.
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Affiliation(s)
| | - Sergio Mazzola
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
| | - Claudio Costantino
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | | | | - Fabio Tramuto
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
| | - Paolo Contiero
- Environmental Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Francesco Vitale
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
| | - Arianna Di Napoli
- Department of Clinical and Molecular Medicine, University of Rome “Sapienza”, Rome, Italy
| | - Walter Mazzucco
- U.O.C. of Clinical Epidemiology with Cancer Registry, Azienda Ospedaliera Universitaria Policlinico di Palermo, Palermo, Italy
- PROMISE Department, University of Palermo, Palermo, Italy
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Breast Implant-associated Anaplastic Large Cell Lymphoma - a Systematic Review with Pooled Analysis. Clin Oncol (R Coll Radiol) 2020; 32:639-646. [PMID: 32732110 DOI: 10.1016/j.clon.2020.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/07/2020] [Accepted: 05/27/2020] [Indexed: 11/24/2022]
Abstract
The association of breast implants and anaplastic large cell lymphoma (BIA-ALCL) was first described in 1997. Such an association has aroused public health concerns on breast implant safety. A systematic review was carried out with a pooled analysis of data. In total, 674 non-duplicate articles were retrieved; 77 articles were included for data extraction; 395 patients were identified for analysis. The median age at the time of diagnosis was 52 years. Implant texture was described in 201 (50.9%) patients; all 201 patients had a textured implant. The median time from the last implant insertion to diagnosis was 7.5 years. Most patients presented with seroma (67.1%, n = 265), 20.5% of patients presented with breast mass (n = 81). Patients with a breast mass at presentation, lymphadenopathy and those without seroma had more disseminated disease (P < 0.001). 73.2% of patients (n = 289) opted for primary surgery, among which 68.6% (n = 271) received removal of the implant, 61% (n = 241) received capsulectomy and 2% (n = 8) received mastectomy. Of note, 5.3% (n = 21) had reinsertion of an implant after primary surgery. Non-surgical modalities included chemotherapy, radiotherapy and haematopoietic stem cell transplant. The median follow-up interval was 2 years (range 0-14.5 years). Seventeen patients (4.3%) had recurrence of BIA-ALCL and 195 patients (49.4%) did not. The median duration to first recurrence was 1 year (range 1-3 years). Long-term clinical outcome was not reported in 183 patients. BIA-ALCL is an indolent disease that presents with seroma after implant insertion. A high index of suspicion is needed for early diagnosis and treatment.
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Quesada AE, Medeiros LJ, Clemens MW, Ferrufino-Schmidt MC, Pina-Oviedo S, Miranda RN. Breast implant-associated anaplastic large cell lymphoma: a review. Mod Pathol 2019; 32:166-188. [PMID: 30206414 DOI: 10.1038/s41379-018-0134-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 12/23/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma is a newly recognized provisional entity in the 2017 revision of the World Health Organization Classification of Tumors of Hematopoietic and Lymphoid Tissues. It is an uncommon, slow growing T-cell lymphoma with morphology and immunophenotype similar to anaplastic lymphoma kinase-negative anaplastic large cell lymphoma. However, the presentation and treatment are unique. Breast implant-associated anaplastic large cell lymphoma often presents as a unilateral effusion confined to the capsule of a textured-surface breast implant, a median time of 9 years after the initial implants have been placed. Although it follows an indolent clinical course, breast implant-associated anaplastic large cell lymphoma has the potential to form a mass, to invade locally through the capsule into breast parenchyma or soft tissue and/or to spread to regional lymph nodes. In most cases, an explantation with a complete capsulectomy removing all disease, without chemotherapy is considered to be curative and confers an excellent event free and overall survival. Here we provide a comprehensive review of breast implant-associated anaplastic large cell lymphoma, including history, epidemiology, clinical features, imaging and pathology findings, pathologic handling, pathogenic mechanisms, model for progression, therapy and outcomes as well as an analysis of causality between breast implants and anaplastic large cell lymphoma.
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Affiliation(s)
- Andrés E Quesada
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sergio Pina-Oviedo
- Department of Pathology and Laboratory Services, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Ramos-Gallardo G, Cuenca-Pardo J, Cardenas-Camarena L, Duran-Vega H, Rodríguez-Olivares E, Bayter-Marin JE, Levelier De Doig Alvear G, Vazquez G, Fontbona-Torres M, Galán-Suárez R, Guzman-Stein G, Guzmán-Padilla S, Echeverría-Roldán G, Silva-Gavarrete JF, Vallarta-Rodríguez A, Contreras-Bulnes L, Oaxaca-Escobar CG, Caravantes-Cortes I, Flores ME, Cowes-McGowen J, Maciel-Sosa ML, Delgado-Binasco R, Rincón-Rubio L. Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico. Aesthetic Plast Surg 2018; 42:1421-1428. [PMID: 29770862 DOI: 10.1007/s00266-018-1148-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/28/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Guillermo Ramos-Gallardo
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico.
| | - Jesus Cuenca-Pardo
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Lazaro Cardenas-Camarena
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Hector Duran-Vega
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Eugenio Rodríguez-Olivares
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Jorge Enrique Bayter-Marin
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Gerardo Levelier De Doig Alvear
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Guillermo Vazquez
- Sociedad Argentina de Cirugía Plástica Estética y Reconstructiva, Federación Iberolatinoamericana de Cirugía Plástica, Buenos Aires, Argentina
| | | | - Ricardo Galán-Suárez
- Sociedad Colombiana de Cirugía Plástica Estética y Reconstructiva, Cartagena, Colombia
| | - Gabriela Guzman-Stein
- Asociación Costarricense de Cirugía Plástica Estética y Reconstructiva, San José, Costa Rica
| | - Sergio Guzmán-Padilla
- Sociedad Dominicana de Cirugía Plástica Reconstructiva y Estética, Punta Cana, Dominican Republic
| | | | | | - Alfonso Vallarta-Rodríguez
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Livia Contreras-Bulnes
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Carlos Guillemro Oaxaca-Escobar
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | - Isabel Caravantes-Cortes
- Asociación Mexicana de Cirugía Plástica Estética y Reconstructiva, Flamencos No. 74 esquina con Félix Parra Col. San José Insurgentes Delegación, 03900, Benito Juárez Distrito Federal, Mexico
| | | | - Jorge Cowes-McGowen
- Asociación Panameña de Cirugía Plástica Estética y Reconstructiva, Panama City, Panama
| | - María Liz Maciel-Sosa
- Sociedad Paraguaya de Cirugía Plástica Estética y Reconstructiva, Asunción, Paraguay
| | | | - Linda Rincón-Rubio
- Sociedad Venezolana de Cirugía Plástica Estética, Reconstructiva y Maxilofacial, Caracas, Venezuela
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Elswick SM, Nguyen MDT. Breast Erythema in a Patient With Breast Implant-Associated Anaplastic Large Cell Lymphoma: A Case Report Discussing Cutaneous Manifestations. Aesthet Surg J 2018; 38:NP47-NP52. [PMID: 29190331 DOI: 10.1093/asj/sjx209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
LEVEL OF EVIDENCE 5
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6
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Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon neoplasia occurring in women with either cosmetic or reconstructive breast implants. The actual knowledge about BIA-ALCL deriving from the literature presents several limits, and it remains difficult to make inferences about BIA-ALCL epidemiology, cause, and pathogenesis. This is the reason why the authors decided to organize an evidence-based consensus conference during the Maurizio Bruno Nava (MBN 2016) Aesthetic Breast Meeting held in Milan in December of 2016. Twenty key opinion leaders in the field of plastic surgery from all over the world have been invited to express and discuss their opinion about some key questions on BIA-ALCL, trying to reach a consensus about BIA-ALCL cause, pathogenesis, diagnosis, and treatment in light of the actual best evidence.
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7
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8
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Faenza M, Ronchi A, Santoriello A, Rubino C, Pieretti G, Guastafierro A, Ferraro GA, Nicoletti GF. What's new on primary Hodgkin's lymphoma of the breast? A case report and review of the literature. Int J Surg Case Rep 2017; 38:149-153. [PMID: 28759828 PMCID: PMC5537453 DOI: 10.1016/j.ijscr.2017.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/13/2017] [Accepted: 07/15/2017] [Indexed: 11/30/2022] Open
Abstract
A subtle case report of primary Hodgkin’s disease of the breast. Definition and staging of primary lymphomas of the breast. A comprehensive review of the Literature about this kind of disease.
Introduction According to literature, primary Hodgkin’s lymphomas of the breast represent one of the rarer entity in the primary breast lymphoma (PBL) scenario. This is the reason why these tumors are insidious in mammary oncology. Presentation of the case We report a case of HL primitive breast in an elderly patient in whom radiology suspected an advanced breast cancer with ipsilateral axillary involvement and in which the fine-needle aspiration came back not significant. Discussion Eighteen cases of primary Hodgkin’s lymphoma of the breast has been described in Literature in a very large period of time: from 1928 to 2016. The nodular sclerosis type is the most frequent histological variant. Conclusion Their rarity together with the fact that radiological investigations are not significant for the purpose of an exact diagnosis, make these lesions extremely difficult to identify.
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Affiliation(s)
- Mario Faenza
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Ph.D. School in Traslational Medicine of Development and Active Aging, Università di Salerno, Salerno, Italy
| | - Andrea Ronchi
- Department of Mental and Physical Health and Preventive Medicine, Pathology Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Santoriello
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Dentistry, Plastic Surgery Unit, Università di Salerno, Salerno, Italy.
| | - Gorizio Pieretti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Guastafierro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Andrea Ferraro
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Francesco Nicoletti
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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Clemens MW, Nava MB, Rocco N, Miranda RN. Understanding rare adverse sequelae of breast implants: anaplastic large-cell lymphoma, late seromas, and double capsules. Gland Surg 2017; 6:169-184. [PMID: 28497021 DOI: 10.21037/gs.2016.11.03] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a distinct type of T-cell lymphoma arising around breast implants. The United States FDA recently updated the 2011 safety communication, warning that women with breast implants may have a very low risk of developing ALCL adjacent to a breast implant. According to the World Health Organization, BI-LCL is not a breast cancer or cancer of the breast tissue; it is a lymphoma, a cancer of immune cells. BI-ALCL is highly curable in the majority of patients. Informed consent should include the risk of BI-ALCL with breast implant patients. Women with breast implants are encouraged to contact their plastic surgeon if they notice swelling, fluid collections, or unexpected changes in breast shape. Physicians are encouraged to send suspicious peri-prosthetic fluid for CD30 immunohistochemistry, cell block cytology, and culture in symptomatic patients. An observation from reported cases indicates a predominance of textured device involvement. More information is needed to fully understand risk factors and etiology. The association of bacteria and biofilm with ALCL is currently being investigated and one theory is that biofilm may play a role in this disease process stressing the importance of best practice techniques intraoperatively. Recent studies have reported clinical presentation, prognosis, and treatment outcomes with long term followup demonstrating the critical role for surgical management.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Roberto N Miranda
- Department of Hematopathology, the University of Texas M.D. Anderson Cancer, Center, Houston, TX, USA
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Ramos-Gallardo G, Cuenca-Pardo J, Rodríguez-Olivares E, Iribarren-Moreno R, Contreras-Bulnes L, Vallarta-Rodríguez A, Kalixto-Sanchez M, Hernández C, Ceja-Martinez R, Torres-Rivero C. Breast Implant and Anaplastic Large Cell Lymphoma Meta-Analysis. J INVEST SURG 2016; 30:56-65. [DOI: 10.1080/08941939.2016.1215576] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alhamad S, Guerid S, El Fakir EH, Biron P, Tourasse C, Delay E. [Breast implant-associated anaplastic large cell lymphoma. Case report of an undiagnosed form, management and reconstruction (ALCL)]. ANN CHIR PLAST ESTH 2016; 61:223-30. [PMID: 27107559 DOI: 10.1016/j.anplas.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (ALCL) is an extremely rare disease. Is a new nosologic entity with a multifactorial origin and a wide occurrence delay after breast implantation. This article reports the case of a 60 years old patient with a progressive swelling of the right breast after aesthetic breast implants. Diagnostic was delayed because first surgeon was not familiar with the disease. Patient was then referred to us for management. We performed an implant removal and a complete capsulectomy. Pathologic report confirms the diagnostic. After one year and normal ultrasound evaluation, we reconstructed the breast with lipomodeling and mastopexy. Contralateral implant was also removed at time of reconstruction. Vast majority of breast implant-associated ALCL occurs at a time lapse of 11 to 15 years after implant augmentation, with a mean age of 63 years. Among the worldwide 173 cases reported in March 2015, smooth implants seem not to be at risk but 80% of cases were associated with macrotexturized implants. Clinical presentation and diagnostic tools are more and more published but there is to date no recommendation concerning reconstruction delay after implant removal for this pathology. We advise the realization of a breast ultrasound every three months during the first year and wait for a one-year period before reconstruction. In case of aesthetic surgery, mastopexia can be done to allow for glandular shaping. Lipomodeling is an excellent technique to correct the lack of volume due to implant removal. In case of reconstructive setting, implant can be replaced by flap procedure with lipomodeling if needed or lipomodeling alone if recipient site is favorable and patient has enough fat tissue. Contralateral implant should be removed during reconstruction time.
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Affiliation(s)
- S Alhamad
- Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France
| | - S Guerid
- Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France.
| | - E H El Fakir
- Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France
| | - P Biron
- Département d'oncologie médicale, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France
| | - C Tourasse
- Hôpital privé Jean-Mermoz, 55, avenue Jean-Mermoz, 69008 Lyon, France
| | - E Delay
- Unité de chirurgie plastique et reconstructrice, centre Léon-Bérard, 28, rue Laënnec, 69373 Lyon cedex 08, France; Cabinet privé, 50, rue de la République, 69002 Lyon, France.
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12
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Bizjak M, Selmi C, Praprotnik S, Bruck O, Perricone C, Ehrenfeld M, Shoenfeld Y. Silicone implants and lymphoma: The role of inflammation. J Autoimmun 2015; 65:64-73. [PMID: 26330346 DOI: 10.1016/j.jaut.2015.08.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/14/2015] [Accepted: 08/17/2015] [Indexed: 12/18/2022]
Abstract
The risk of hematological malignancies is mainly determined by genetic background, age, sex, race and ethnicity, geographic location, exposure to certain chemicals and radiation; along with the more recently proposed immune factors such as chronic inflammation, immunodeficiencies, autoimmunity, and infections. Paradigmatic examples include the development of lymphoma in Sjögren's syndrome and Hashimoto thyroiditis, gastric MALT lymphoma in Helicobacter pylori infection, or lymphomas associated with infections by Epstein-Barr virus, human herpes virus 8 (HHV 8) and leukemia/lymphoma virus 1 (HTLV-1). A growing number of reports indicates an increased risk of lymphoma, particularly of the anaplastic large cell (ALCL) type. The implants, specifically those used in the past, elicit chronic stimulation of the immune system against the prosthetic material. This is particularly the case in genetically susceptible hosts. We suggest that polyclonal activation may result in monoclonality in those at risk hosts, ultimately leading to lymphoma. We suggest that patients with an inflammatory response against silicone implants be monitored carefully.
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Affiliation(s)
- Mojca Bizjak
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, Humanitas Research Hospital, Milan, Italy; BIOMETRA Department, University of Milan, Milan, Italy
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Or Bruck
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Carlo Perricone
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Rheumatology, Department of Medicine, Sapienza Univerisity of Rome, Rome, Italy
| | - Michael Ehrenfeld
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- The Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Incumbent of the Laura Schwarz-kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
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13
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Clemens MW, Miranda RN. Coming of Age: Breast Implant-Associated Anaplastic Large Cell Lymphoma After 18 Years of Investigation. Clin Plast Surg 2015; 42:605-13. [PMID: 26408447 DOI: 10.1016/j.cps.2015.06.006] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Breast implant associated anaplastic large cell lymphoma (BIALCL) is a distinct clinical entity that can present in patients receiving either reconstructive or cosmetic breast implants. Presenting symptoms include onset of a delayed (>1 year after implantation) fluid collection, mass of the capsule, or lymphadenopathy. Treatment has progressed in recent years and most commonly includes implant removal and total resection of the tumor, including capsule, mass, and involved lymph nodes. Further research is warranted to determine potential malignant drivers, disease progression, and optimal treatment strategies in advanced disease.
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Affiliation(s)
- Mark W Clemens
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1488, Houston, TX 77030, USA.
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0072, Houston, TX 77030, USA
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Rupani A, Frame JD, Kamel D. Lymphomas Associated with Breast Implants: A Review of the Literature. Aesthet Surg J 2015; 35:533-44. [PMID: 26116741 DOI: 10.1093/asj/sjv016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently there have been concerns raised about anaplastic large cell lymphoma (ALCL) associated with breast implants. OBJECTIVES The main aim of this article was to review and analyze the published literature specifically for hematopoietic malignancies associated with breast implants and postulate a hypothesis for their etiology and pathogenesis. METHODS The PubMed database was searched using key words "lymphoma" and "breast implants" for published papers and abstracts on implant-associated hematopoietic malignancies. RESULTS The authors found 83 published cases reported of lymphomas associated with breast implants in the medical literature. The reported cases involved various subtypes of lymphomas and the majority were ALCL, of which 66 were confirmed as ALK negative; however there was no association with any particular type of implant. The more aggressive cases and reported low death rate appeared to be related to the presence of breast masses at the time of presentation rather than effusion. The remaining reports were occasional case reports of T-cell lymphoma, follicular lymphoma, marginal zone B-cell lymphoma, primary effusion lymphoma and lymphoplasmacytic lymphoma. CONCLUSIONS Considering the many thousands of women that have breast implants every year; the compiled data show that there is a very small risk of developing lymphoma. Increased awareness of association between implants and ALCL is needed globally and prospective patients considering breast implants should be fully informed of the risk. As the behavior of ALCL in these cases was indolent as compared with other primary breast lymphomas, it could suggest an abnormal reactive process. LEVEL OF EVIDENCE 3
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Affiliation(s)
- Asha Rupani
- Dr Rupani is a Specialist Registrar and Dr Kamel is a Consultant Histopathologist, Department of Histopathology, Broomfield Hospital, Chelmsford, United Kingdom. Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, United Kingdom
| | - James D Frame
- Dr Rupani is a Specialist Registrar and Dr Kamel is a Consultant Histopathologist, Department of Histopathology, Broomfield Hospital, Chelmsford, United Kingdom. Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, United Kingdom
| | - Dia Kamel
- Dr Rupani is a Specialist Registrar and Dr Kamel is a Consultant Histopathologist, Department of Histopathology, Broomfield Hospital, Chelmsford, United Kingdom. Dr Frame is a Professor of Aesthetic Plastic Surgery at the Post Graduate Medical Institute, Anglia Ruskin University (Chelmsford and Cambridge), Chelmsford, United Kingdom
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Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg 2015; 135:695-705. [PMID: 25490535 DOI: 10.1097/prs.0000000000001033] [Citation(s) in RCA: 235] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The first silicone breast implant was inserted in 1962. In 1997, the first case of anaplastic large cell lymphoma (ALCL) in association with a silicone breast implant was reported. The authors reviewed 37 articles in the world literature reporting on 79 patients and collected another 94 unreported cases as of the date of submission. METHODS The world literature was reviewed. Missing clinical and laboratory information was solicited from the authors and treating physicians. As several different specialties were involved, information was not in one place. Many (but not all) authors and treating physicians were responsive, resulting in incomplete data. RESULTS ALCL lesions first presented as late peri-implant seromas, a mass attached to the capsule, tumor erosion through the skin, in a regional node, or discovered during revision surgery. The clinical course varied widely from a single positive cytology result followed by apparent spontaneous resolution, to disseminated treatment-resistant tumor and death. There was no preference for saline or silicone fill or for cosmetic or reconstructive indications. Where implant history was known, the patient had received at least one textured-surface device. Extracapsular dissemination occurred in 18 cases; nine of those were fatal. Histochemical markers were primarily CD-30 and Alk-1. Other markers occurred at a lower frequency. Risk estimates ranged from one in 500,000 to one in 3 million women with implants. CONCLUSION Breast implant-associated ALCL is a novel manifestation of site- and material-specific lymphoma originating in a specific scar location, presenting a wide array of diverse characteristics and suggesting a multifactorial cause.
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Abstract
BACKGROUND There is substantial evidence that a type of anaplastic large cell lymphoma (ALCL) is associated with breast implants. However, the course in patients with breast implants seems to be unusually benign compared with other systemic ALCL. The purpose of this study was to identify and analyze recently published cases of breast implant-associated ALCL, with an emphasis on diagnosis, staging, treatment, and outcomes. METHODS The authors conducted a systematic literature review of reported cases of ALCL in patients with breast implants. Publications were identified with a search algorithm and forward searches. Case-based data were abstracted independently and reconciled by multiple investigators. RESULTS Of 248 identified articles, only 102 were relevant to breast implant-associated ALCL, and 27 were included in this study. Fifty-four cases of ALCL in patients with breast implants were identified. Detailed clinical information was lacking in many cases. Most presented with a seroma (76 percent), and approximately half were associated with the capsule (48 percent). Most presented as stage IE (61 percent). All but one case were ALK-negative. Most received chemotherapy (57 percent) and radiation therapy (48 percent), and 11 percent received stem cell transplants. Approximately one-quarter recurred, and 9 percent died. CONCLUSIONS Since the publication of guidance related to breast implant-associated ALCL in 2010, a number of cases have been reported. Despite the typically benign course, many of the cases have been treated with radiation therapy and/or chemotherapy. Increasing awareness of this disease entity among clinicians would be helpful, along with standardizing an approach to diagnosis, staging, and treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, V.
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Hwang MJ, Brown H, Murrin R, Momtahan N, Sterne GD. Breast implant-associated anaplastic large cell lymphoma: a case report and literature review. Aesthetic Plast Surg 2015; 39:391-5. [PMID: 25740078 DOI: 10.1007/s00266-015-0463-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/15/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare new clinical entity. The incidence is 0.3 % per 100,000 women per year. Patients present with non-specific implant-related complications resulting in delayed diagnosis. We present such a case to raise awareness and discuss management. A 48-year-old female presented with a 3-month history of left breast pain and swelling. She had undergone multiple bilateral augmentations 8 years previously. Triple assessment revealed a seroma, and a magnetic resonance imaging scan excluded implant rupture. Cytology showed a typical cells with mitotic activity which lead to removal of implants and a left capsulectomy. Final histology revealed an anaplastic lymphoma kinase (ALK) negative ALCL confined to the capsule. A computerised tomography scan and bone marrow biopsy excluded systemic disease, but due to later identified B symptoms, she received CHOP chemotherapy under the care of the haematologists. ALK-negative ALCL is associated with breast implants, and any persistent late onset seroma or breast symptoms should raise the suspicion of ALK-negative ALCL as a differential diagnosis. The recommended treatment is surgical removal of the implant including a full capsulectomy, highlighting the suspicion of ALCL to the pathologist. Exclusion of systematic disease is also recommended in all patients, and the need for adjuvant therapy should be addressed on an individual case basis. For disease confined to the capsule, adjuvant chemoradiotherapy is not needed. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
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Affiliation(s)
- Mei-Ju Hwang
- Birmingham City Hospital, Sandwell & West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK,
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Breast Implant-associated Anaplastic Large Cell Lymphoma: Updated Results from a Structured Expert Consultation Process. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e296. [PMID: 25674377 PMCID: PMC4323400 DOI: 10.1097/gox.0000000000000268] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/01/2014] [Indexed: 12/25/2022]
Abstract
Background: Despite increased cases published on breast implant–associated anaplastic large cell lymphoma (BIA-ALCL), important clinical issues remain unanswered. We conducted a second structured expert consultation process to rate statements related to the diagnosis, management, and surveillance of this disease, based on their interpretation of published evidence. Methods: A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States. Results: Panelists agreed that (1) this disease should be called “BIA-ALCL”; (2) late seromas occurring >1 year after breast implantation should be evaluated via ultrasound, and if a seroma is present, the fluid should be aspirated and sent for culture, cytology, flow cytometry, and cell block to an experienced hematopathologist; (3) surgical removal of the affected implant and capsule (as completely as possible) should occur, which is sufficient to eradicate capsule-confined BIA-ALCL; (4) surveillance should consist of clinical follow-up at least every 6 months for at least 5 years and breast ultrasound yearly for at least 2 years; and (5) BIA-ALCL is generally a biologically indolent disease with a good prognosis, unless it extends beyond the capsule and/or presents as a mass. They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL. Conclusions: Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.
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Ramos R, Ureña A, Martinez S, Spuch JA, Vallansot R. Giant-cell anaplastic lymphoma in an open thoracostomy cavity. Cir Esp 2014; 93:670-2. [PMID: 25438775 DOI: 10.1016/j.ciresp.2014.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 06/30/2014] [Accepted: 07/02/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Ricard Ramos
- Servicio de Cirugía Torácica y Unidad de Anatomía Humana y Embriología, Hospital Universitari de Bellvitge, Universitat de Barcelona, ĹHospitalet de Llobregat, Barcelona, España.
| | - Anna Ureña
- Servicio de Cirugía Torácica, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, España
| | - Salome Martinez
- Servicio de Anatomía Patológica, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, España
| | - Juan Antonio Spuch
- Servicio de Cirugía General y Digestiva/Unidad de Hospitalización a Domicilio, Hospital Joan XXIII, Universitat Rovira i Virgili, Tarragona, España
| | - Rolando Vallansot
- Servicio de Hematología, Hospital Joan XXIII, Universitat Rovira I Virgili, Tarragona, España
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Hart AM, Lechowicz MJ, Peters KK, Holden J, Carlson GW. Breast Implant-Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature. Aesthet Surg J 2014; 34:884-94. [PMID: 24938778 DOI: 10.1177/1090820x14539503] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2014] [Indexed: 11/17/2022] Open
Abstract
Although primary breast lymphomas are exceedingly rare, cases of breast implant-associated anaplastic large cell lymphoma (iALCL) continue to be reported. The authors describe their experience with 2 patients and review the literature. Both patients presented with periprosthetic fluid collection. Neither had evidence of systemic disease nor received systemic therapy. Both were disease free after bilateral capsulectomies and implant removal without implant replacement, and disease did not recur. During the literature review, 63 cases of iALCL (including our 2 patients) were identified. The median time from implant placement to diagnosis was 9 years. Both saline and silicone implants were associated with iALCL. Of the 26 cases for which implant surface was reported, the surface was textured in 24. Of the 58 patients with an identifiable presentation, 39 had periprosthetic fluid collection, including 7 with an associated mass; 13 had an isolated mass at presentation, including 1 with axillary adenopathy. Forty patients had capsulectomy, 7 of whom underwent implant replacement. Of the 44 patients with known treatment, 33 received chemotherapy and 23 received radiation. Of the 49 patients with known anaplastic large cell lymphoma, 15 had disease recurrence, and 4 patient deaths were reported. Of the 18 patients presenting with a mass, 11 had disease recurrence, including all 4 patients who died. This study represents the largest review of patients with iALCL described to date. Although most cases have an indolent clinical course, the variety of presentations defined as "seroma" vs "capsular involvement" emphasizes the importance of investigating a definitive method of diagnosis, management, and treatment of this disease. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Alexandra M Hart
- Dr Hart is a resident in the Department of General Surgery at Emory University
| | - Mary Jo Lechowicz
- Dr Lechowicz is an Associate Professor in the Department of Hematology and Medical Oncology, Winship Cancer Institute
| | - Kendall K Peters
- Dr Peters is a plastic surgeon in private practice in Orlando, Florida
| | - Jeannine Holden
- Dr Holden is the Director of Hematopathology and Fly Cytometry
| | - Grant W Carlson
- Dr Carlson is the Chief of the Division of Plastic Surgery at Emory University, Atlanta, Georgia
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Breast implant-associated anaplastic large cell lymphoma: sensitivity, specificity, and findings of imaging studies in 44 patients. Breast Cancer Res Treat 2014; 147:1-14. [PMID: 25073777 DOI: 10.1007/s10549-014-3034-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Breast implant-associated anaplastic large cell lymphoma (BIA ALCL) is a newly described clinicopathologic entity. The purpose of this study is to describe the imaging findings of patients with BIA ALCL and determine their sensitivity and specificity in the detection of the presence of an effusion or a mass related to BIA ALCL. A retrospective search was performed of our files as well as of the world literature for patients with pathologically proven BIA ALCL who had been assessed by any imaging study including ultrasound (US), computerized tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT, as well as mammography. The sensitivity and specificity of each imaging modality in the detection of an effusion or a mass around breast implants was determined. We identified 44 patients who had BIA ALCL and imaging studies performed between 1997 and 2013. The sensitivity for detecting an effusion was 84, 55, 82, and 38 %, and for detecting a mass was 46, 50, 50, and 64 %, by US, CT, MRI, and PET, respectively. The sensitivity of mammography in the detection of an abnormality without distinction of effusion or mass was 73 %, and specificity 50 %. Progression-free survival was worse in patients with an implant-associated mass (p = 0.001). CONCLUSIONS Current imaging with US, CT, MR, and PET appears suboptimal in the detection of an imaging abnormality associated with BIA ALCL. This under diagnosis may reflect a lack of awareness of this rare entity suggesting the need for better understanding of the spectrum of imaging findings associated with BIA ALCL by breast imagers.
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