Breast implant associated anaplastic large cell lymphoma: Impact and implications

BIA-ALCL Epidemiological Findings From a Retrospective Study of 248 Cases Extracted from Relevant Case Reports and Series: A Systematic Review

BACKGROUND

The epidemiologic picture of Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL) is unclear, with no high-level evidence, as only case reports and series are available.

OBJECTIVES

We aimed at updating the BIA-ALCL epidemiology by using all available data through a systematic review of scientific literature.

METHODS

A search on PubMed, Scopus, and Web of Science was conducted between October 2021 and April 2022. Out of the 2,799 available records, we selected 114 pertinent articles, featuring 248 BIA-ALCL cases which were retrospectively analyzed by means of descriptive statistics, incidence rate (IR), Kaplan-Meier survival curves and Pearson correlation coefficient.

RESULTS

United States, Netherlands, Italy, and Australia were the most reporting countries. Mean age at 1st implantation was 42y, and 53y at diagnosis. Aesthetic indication was 52% and reconstructive 48%, macrotextured surface was linked to 73.8% of cases and seroma to 83%. Total follow-up was 492 months, mean Event Free Time (EFT) to BIA-ALCL development was 129 months. IR was 96 new cases/1.000 women per year after first implantation, and directly correlated to number of replacements. EFT was directly correlated to number of replacements, implant rupture and capsule contracture, while inversely associated to patients' age at first implantation and to BRACA1/2 and TP53 mutations.

CONCLUSIONS

Macrotextured implants use in older patients and in BRCA1/2 and TP53 mutated should be reconsidered, being associated to earlier disease onset. Implant replacement of asymptomatic, risk-stratified patients, can be indicated due to its protective role against BIA-ALCL, reducing IR rate and risk, while increasing the EFT.

Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL): Review of Epidemiology and Prevalence Assessment in Europe

BACKGROUND

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) epidemiologic studies focus on incidence and risk estimates.

OBJECTIVES

The aim of this study was to perform a thorough literature review, and to provide an accurate estimate of BIA-ALCL prevalence in Europe.

METHODS

We searched PubMed, Web of Science, SCOPUS, and Google Scholar databases to identify publications reporting BIA-ALCL epidemiology. Research was conducted between November 2019 and August 2020. European prevalence was assessed as the ratio between pathology-confirmed cases and breast implant-bearing individuals. The Committee on Device Safety and Development (CDSD) collected data from national plastic surgery societies, health authorities, and disease-specific registries to calculate the numerator. The denominator was estimated by combining European demographic data with scientific reports.

RESULTS

Our research identified 507 articles: 106 were excluded for not being relevant to BIA-ALCL. From the remaining 401 articles, we selected 35 that discussed epidemiology and 12 reviews. The CDSD reported 420 cases in Europe, with an overall prevalence of 1:13,745 cases in the 28 member states of the European Union (EU-28). Countries where specific measures have been implemented to tackle BIA-ALCL account for 61% of the EU-28 population and actively reported 382 cases with an overall prevalence of 1:9121.

CONCLUSION

Countries where specific measures have been implemented show a higher prevalence of BIA-ALCL compared with the European mean, suggesting that these countries have improved the detection of the condition and reduced underreporting, which affects the numerator value. Other nations should adopt projections based on these measures to avoid underestimating how widespread BIA-ALCL is.

LEVEL OF EVIDENCE: 4