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Tajiri W, Shimamoto R, Koga Y, Kawasaki J, Higuchi M, Nakamura Y, Koi Y, Koga C, Ijichi H, Choi I, Suehiro Y, Taguchi K, Tokunaga E. A case of BIA-ALCL in which postoperative chest wall recurrence was highly suspected: the third reported case of BIA-ALCL in Japan. Surg Case Rep 2024; 10:196. [PMID: 39177840 PMCID: PMC11343931 DOI: 10.1186/s40792-024-01996-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a rare malignancy. Many cases of BIA-ALCL are identified based on the presence of late-onset effusion and/or masses. Importantly, the United States Food and Drug Administration noted that in all cases diagnosed in patients with textured implants, the patients either had a history of mixed implantation of smooth and textured devices or no clinical history was supplied for review. In Japan, the first case of BIA-ALCL was reported in 2019, and we encountered the third case in Japan in December 2021. There have been a total of five cases of BIA-ALCL previously reported at Japanese academic conferences (Japan Oncoplastic Breast Surgery Society. http://jopbs.umin.jp/medical/index.html ), of which only the first case has been published. Unlike the first case, this patient had clinical features that were highly suggestive of the postoperative chest wall recurrence of breast cancer, with a mass and rash on the skin. CASE PRESENTATION The patient was a 45-year-old woman who had undergone breast reconstruction after breast cancer surgery of the right breast 8 years previously. The patient presented with a mass and skin rash inside the inframammary area, and we suspected a damaged silicone breast implant (SBI) or chest wall recurrence. We examined the mass by a core needle biopsy and made a pathological diagnosis of BIA-ALCL. Imaging findings suggested internal thoracic lymph node swelling and lymphoma infiltration beyond the capsule but no metastatic lesions (cStage III). After en bloc resection of the SBI and lymphoma, adjuvant systemic therapy was performed. CONCLUSION We encountered the third case of BIA-ALCL in Japan. This was a case with clinically advanced stage of disease; however, the BIA-ALCL was found to be in remission.
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Affiliation(s)
- Wakako Tajiri
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Ryo Shimamoto
- Department of Plastic Surgery, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yutaka Koga
- Department of Pathology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Junji Kawasaki
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Makiko Higuchi
- Department of Hematology and Cell Therapy, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yoshiaki Nakamura
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Yumiko Koi
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Chinami Koga
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Hideki Ijichi
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Ilseung Choi
- Department of Hematology and Cell Therapy, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Youko Suehiro
- Department of Hematology and Cell Therapy, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan
| | - Eriko Tokunaga
- Department of Breast Oncology, National Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-Ku, Fukuoka, 811-1395, Japan.
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Xu HH, Abi-Rafeh J, Davison P, Winocour S, Matros E, Vorstenbosch J. Complications of Aesthetic and Reconstructive Breast Implant Capsulectomy: An Analysis of 7486 Patients Using Nationwide Outcomes Data. Aesthet Surg J 2024; 44:936-945. [PMID: 38518757 PMCID: PMC11334206 DOI: 10.1093/asj/sjae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/14/2024] [Accepted: 03/20/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Despite increasing demand for breast capsular surgery to treat various benign and malignant implant-related pathologies, high-quality evidence elucidating complication profiles of capsulectomy and capsulotomy is lacking. OBJECTIVES The aim of this study was to provide the largest-scale analysis of associated outcomes and complications using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) database, and to investigate clinical scenarios that may subject patients to increased risks for complications, most notably extent of capsular surgery (complete vs partial) and index indication of implantation (aesthetic vs reconstructive). METHODS An analysis of the TOPS database from 2008 to 2019 was performed. CPT codes were used to identify complete capsulectomy and partial capsulectomy/capsulotomy cases. Breast implant exchange procedures constituted procedural controls. RESULTS In total, 7486 patients (10,703 breasts) undergoing capsulectomy or capsulotomy were assessed. Relative to controls, capsulectomy (4.40% vs 5.79%), but not capsulotomy (4.40% vs 4.50%), demonstrated higher overall complication rates. Both capsulectomies (0.83% vs 0.23%) and capsulotomies (0.56% vs 0.23%) also had greater rates of seroma relative to controls. Subgroup analyses demonstrated that reconstructive patients, relative to aesthetic patients, experienced greater overall complications (6.76% vs 4.34%), and increased risks for seroma (1.06% vs 0.47%), dehiscence (0.46% vs 0.14%), surgical site infections (1.03% vs 0.23%), and implant loss (0.52% vs 0.23%). A detailed synthesis of 30-day outcomes, including all patient- and breast-specific complications, for both capsulectomy and capsulotomy, stratified according to all potential confounders, is presented herein. CONCLUSIONS Surgeries on the breast capsule are safe overall, although complete capsulectomies and reconstructive patients are associated with significantly increased operative risks. The present findings will enhance patient selection, counseling, and informed consent. LEVEL OF EVIDENCE: 3
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Affiliation(s)
| | | | | | | | | | - Joshua Vorstenbosch
- Corresponding Author: Dr Joshua Vorstenbosch, McGill University, Royal Victoria Hospital, 1001 Boul Decarie, Room D02.7007, Montreal, Quebec H4A 3J1, Canada. E-mail:
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Yuan Y, Du F, Xiao Y, Huang J, Long X. Severe capsular contracture in a patient with a history of multiple malignancies - Hematoma or neoplasm recurrence?: A case report. Medicine (Baltimore) 2024; 103:e39074. [PMID: 39093798 PMCID: PMC11296467 DOI: 10.1097/md.0000000000039074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/04/2024] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Complications associated with breast implants pose a significant obstacle to improving the quality of life for patients undergoing implant-based breast reconstruction. Due to the intricate nature of their presentation, diagnosis often becomes challenging and perplexing. Herein, we present a case report detailing the diagnostic and therapeutic processes employed in managing implant-related complications in a patient with multiple malignancies who underwent immediate breast reconstruction following mastectomy. PATENT CONCERNS The patient, a 48-year-old woman, presented with severe pain and hardening in her left breast. She had previously undergone nipple-sparing mastectomy followed by immediate implant-based breast reconstruction 3 years ago. DIAGNOSES Upon admission, we suspected a simple diagnosis of capsular contracture. However, upon investigation, she had a medical history of colon cancer, breast cancer, and acute B-lymphoblastic leukemia. Furthermore, she recently experienced nipple hemorrhage. INTERVENTIONS Considering her clinical manifestations, we postulated the possibility of tumor recurrence along with potential presence of breast implant-associated anaplastic large cell lymphoma. The situation took a new turn, as diagnostic imaging techniques including breast MRI, and ultrasound revealed indications of potential prosthesis rupture and periprosthetic infection. OUTCOMES Ultimately, en bloc capsulectomy with implant removal was performed, revealing no evidence of implant rupture or infection but rather indicating delayed hematoma formation. LESSONS An accurate diagnosis of complications associated with breast prosthesis reconstruction is crucial for effective treatment. The examination and treatment processes employed in this case offer valuable insights toward achieving a more precise diagnosis of prosthesis-related complications, particularly in patients with complex medical histories.
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Affiliation(s)
- Yutong Yuan
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
- Department of Oncoplastic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengzhou Du
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yiding Xiao
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jiuzuo Huang
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao Long
- Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, China
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Santanelli di Pompeo F, Firmani G, Stanzani E, Clemens MW, Panagiotakos D, Di Napoli A, Sorotos M. Breast Implants and the Risk of Squamous Cell Carcinoma of the Breast: A Systematic Literature Review and Epidemiologic Study. Aesthet Surg J 2024; 44:757-768. [PMID: 38307034 DOI: 10.1093/asj/sjae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
Squamous cell carcinoma may arise primarily from the breast parenchyma (PSCCB) or from the periprosthetic capsule in patients with breast implants (breast implant-associated squamous cell carcinoma [BIA-SCC]). A systematic literature review was performed to identify all PSCCB and BIA-SCC cases, and to estimate prevalence, incidence rate (IR), and risk. Studies up to November 2023 were searched on PubMed, Web of Science, Google Scholar, and Cochrane Library for predefined keywords. The numerator for PSCCB and BIA-SCC was the number of cases obtained from the literature; the denominator for PSCCB was the female population aged from 18 to 99, and the denominator for BIA-SCC was the population with breast implants. Overall, 219 papers were included, featuring 2250 PSCCB and 30 BIA-SCC cases. PSCCB prevalence was 2.0 per 100,000 (95% CI, 0.2:100,000 to 7.2:100,000) individuals, with a lifetime risk of 1:49,509 (95% CI, 0.2:10,000 to 5.6:10,000); and BIA-SCC prevalence was 0.61 per 100,000 (95% CI, 0.2:100,000 to 1.3:100,000), with a lifetime risk of 1:164,884 (95% CI, 0.2:100,000 to 5.6:100,000). The prevalence of BIA-SCC is 3.33 times lower than that of PSCCB, while the prevalence of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is 3.84 times higher than that of primary breast ALCL. When comparing the BIA-SCC prevalence of 1:164,910 individuals with breast implants regardless of texture to the BIA-ALCL prevalence of 1:914 patients with textured implants, the BIA-SCC risk is 180 times lower than the BIA-ALCL risk. BIA-SCC occurs less frequently than PSCCB and considerably less than BIA-ALCL. The association between textured implants and BIA-SCC cases is relevant for patient education regarding uncommon and rare risks associated with breast implants, and ongoing vigilance, research, and strengthened reporting systems remain imperative.
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Nguyen DL, Grimm LJ, Nelson JS, Johnson KS, Ghate SV. Screening the Implant-Augmented Breast with Digital Breast Tomosynthesis: Is Tomosynthesis Necessary for Non-implant-Displaced Views? JOURNAL OF BREAST IMAGING 2024; 6:261-270. [PMID: 38703091 PMCID: PMC11129616 DOI: 10.1093/jbi/wbae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To determine cancer visualization utility and radiation dose for non-implant-displaced (ID) views using standard protocol with digital breast tomosynthesis (DBT) vs alternative protocol with 2D only when screening women with implant augmentation. METHODS This retrospective cohort study identified women with implants who underwent screening DBT examinations that had abnormal findings from July 28, 2014, to December 31, 2021. Three fellowship-trained breast radiologists independently reviewed examinations retrospectively to determine if the initially identified abnormalities could be visualized on standard protocol (DBT with synthesized 2D (S2D) for ID and non-ID views) and alternate protocol (DBT with S2D for ID and only the S2D images for non-ID views). Estimated exam average glandular dose (AGD) and associations between cancer visualization with patient and implant characteristics for both protocols were evaluated. RESULTS The study included 195 patients (mean age 55 years ± 10) with 223 abnormal findings. Subsequent biopsy was performed for 86 abnormalities: 59 (69%) benign, 8 (9%) high risk, and 19 (22%) malignant. There was no significant difference in malignancy visualization rate between standard (19/223, 8.5%) and alternate (18/223, 8.1%) protocols (P = .92), but inclusion of the DBT for non-ID views found one additional malignancy. Total examination AGD using standard protocol (21.9 mGy ± 5.0) was significantly higher than it would be for estimated alternate protocol (12.6 mGy ± 5.0, P <.001). This remained true when stratified by breast thickness: 6.0-7.9 cm, 8.0-9.9 cm, >10.0 cm (all P <.001). CONCLUSION The inclusion of DBT for non-ID views did not significantly increase the cancer visualization rate but did significantly increase overall examination AGD.
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Affiliation(s)
- Derek L Nguyen
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Lars J Grimm
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Jeffrey S Nelson
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Karen S Johnson
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
| | - Sujata V Ghate
- Department of Radiology, Duke University School of Medicine, Durham, NCUSA
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Ueno K, Sakata Y, Kawaji M, Miyasaka M, Asamura S. Late Hematoma After Feminizing Augmentation Mammoplasty Mimicking Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). EPLASTY 2024; 24:e32. [PMID: 38846510 PMCID: PMC11155343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
We report the case of an Asian transgender patient with late hematoma after feminizing mammoplasty. Bilateral silicone breast implants were inserted into the patient 25 years previously. The right breast gradually became swollen without any specific cause, along with erythema and pain. Positron emission tomography showed right axillary lymphadenopathy. The mass and the axillary lymph node were surgically removed. Pathologic examination of the excised specimen revealed only hematoma formation and inflammatory granulation. At follow-up at 6 months postoperatively there was no reformation of hematoma. The presented symptoms are similar to those of breast implant-associated anaplastic large cell lymphoma, so there can be difficulty in differentiating between these 2 complications. We compared the clinical characteristics between our case of late hematoma and reported breast implant-associated anaplastic large cell lymphoma after feminizing mammoplasty. Life-threatening breast implant-associated anaplastic large cell lymphoma should be ruled out from late hematoma according to the National Comprehensive Cancer Network screening guidelines.
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Affiliation(s)
- Kazuki Ueno
- Department of Plastic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Yasuhiro Sakata
- Department of Plastic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Mari Kawaji
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Miwako Miyasaka
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
| | - Shinichi Asamura
- Department of Plastic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-0012, Japan
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Honda A, Tsuge I, Kitamura K, Ito H, Yamanaka H, Katsube M, Sakamoto M, Morimoto N. Repeated Fluid Accumulation around a Breast Implant Related to Synovial Metaplasia of the Capsule. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5759. [PMID: 38645634 PMCID: PMC11029983 DOI: 10.1097/gox.0000000000005759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/07/2024] [Indexed: 04/23/2024]
Abstract
We must take special care when treating postoperative fluid accumulation around breast implants (BIs) to exclude any serious complications, including BI-associated anaplastic large cell lymphoma. However, most late-onset fluid accumulation is caused by other conditions, such as traumatic hematoma and residual postoperative seroma. Surgeons must choose whether to conservatively observe or remove such BIs, while also determining whether to perform partial capsulectomy or total capsulectomy to solve the problem of fluid accumulation. We treated a 72-year-old woman who noticed swelling in her right breast 4 years after undergoing bilateral BI reconstruction. Before she was referred to our hospital, the fluid had been drained by needle aspiration five times, but the swelling returned to a similar size within a month. No malignant findings were observed by needle-aspirated cytology or flow cytometry. The patient requested the simultaneous removal of the left BI. Therefore, we performed both BI removal with total capsulectomy on the right side and partial capsulectomy of the superficial layer on the left side. A pathological examination of the capsule on the right side indicated a chronic expanding hematoma and synovial metaplasia characterized by papillary projections rich in CD68-positive cells, thus indicating reactive synovial cells. In contrast, the left superficial capsule was much thinner and showed less synovial metaplasia. Our findings indicate the advantages of total capsulectomy to solve the problem of repeated serous fluid accumulation around BIs, according to histological changes in the capsule.
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Affiliation(s)
- Ayano Honda
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Tsuge
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kyohei Kitamura
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroaki Ito
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroki Yamanaka
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Motoki Katsube
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michiharu Sakamoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Naoki Morimoto
- From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Vorstenbosch J, Ghione P, Plitas G, Horwitz S, Kim M, Cordeiro P, Nelson J, McCarthy C. Surgical Management and Long-Term Outcomes of BIA-ALCL: A Multidisciplinary Approach. Ann Surg Oncol 2024; 31:2032-2040. [PMID: 38102324 DOI: 10.1245/s10434-023-14636-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/06/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a subtype of ALCL that arises as a seroma or a mass in the capsule surrounding textured breast implants. However, collections of cases usually come from large groups of institutions or countries, with different approaches regarding surgery and treatment. Here we describe a cohort of 18 cases undergoing implant removal and capsulectomy followed at Memorial Sloan Kettering Cancer Center (MSKCC). PATIENTS AND METHODS We retrospectively analyzed all the cases of women with breast implants undergoing implant removal and capsulectomy for BIA-ALCL at MSKCC from January 2011 to June 2020. RESULTS Median age at diagnosis was 57 (range 35-77) years following a median implant exposure of 11 (range 7-33) years. All known implants were macrotextured with the proprietary Biocell macrotexturing pattern from salt-loss technique. A total of 16 patients (89%) had implants placed for breast cancer reconstruction. Patients presented with clinically evident effusion in 78% of cases and a mass in 17% of cases, and 83% of patients presented with stage 1 BIA-ALCL. Patients were followed for a median of 43.4 months (SD 45 months) after diagnosis. There were no cases of recurrent ALCL. All patients remain disease free and no patients died of ALCL. CONCLUSIONS In this cohort of patients with BIA-ALCL surgically treated and followed at a single institution, we confirm the importance of adequate surgery (bilateral implant removal and complete capsulectomy) in patients presenting with seroma-confined disease. This dataset reinforces high rates of progression-free and overall survival when diagnosis is identified and treatment performed in those with limited-stage disease.
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Affiliation(s)
| | - Paola Ghione
- Lymphoma Section, Department of Medicine, Roswell Park Comprehensive Cancer Centre, Buffalo, NY, USA
| | - George Plitas
- Breast Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven Horwitz
- Hematology and Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Cordeiro
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Colleen McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Chan A, Auclair R, Gao Q, Ghione P, Horwitz S, Dogan A, Roshal M, Lin O. Role of flow cytometric immunophenotyping in the diagnosis of breast implant-associated anaplastic large cell lymphoma: A 6-year, single-institution experience. CYTOMETRY. PART B, CLINICAL CYTOMETRY 2024; 106:117-125. [PMID: 38297808 PMCID: PMC10978229 DOI: 10.1002/cyto.b.22162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/02/2024]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon mature T-cell neoplasm occurring in patients with textured breast implants, typically after 7-10 years of exposure. Although cytopathologic or histopathologic assessment is considered the gold standard diagnostic method for BIA-ALCL, flow cytometry (FC)-based immunophenotyping is recommended as an adjunct test. However, the diagnostic efficacy of FC is not well reported. We reviewed 290 FC tests from breast implant pericapsular fluid and capsule tissue from 182 patients, including 16 patients with BIA-ALCL over a 6-year period, calculating diagnostic rates and test efficacy. FC showed an overall sensitivity of 75.9%, specificity of 100%, and negative and positive predictive values of 95.4% and 100%, respectively. Blinded expert review of false-negative cases identified diagnostic pitfalls, improving sensitivity to 96.6%. Fluid samples had better rates of adequate samples for FC testing compared with tissue samples. Paired with FC testing of operating room (OR)-acquired fluid samples, capsulectomy FC specimens added no diagnostic value in patients with concurrent fluid samples; no cases had positive capsule FC with negative fluid FC. Fluid samples are adequate for FC testing more often than tissue. Capsule tissue FC specimens do not improve FC efficacy when paired with OR-acquired fluid FC samples and are often inadequate samples. FC is 100% specific for BIA-ALCL and can serve as a confirmatory test but should not be the sole diagnostic method. Awareness of sample-specific diagnostic pitfalls greatly improves the sensitivity of BIA-ALCL testing by FC.
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Affiliation(s)
- Alexander Chan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Romany Auclair
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Qi Gao
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Paola Ghione
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Steven Horwitz
- Department of Medicine, Lymphoma Service, Memorial Sloan Kettering Cancer Center
| | - Ahmet Dogan
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Mikhail Roshal
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
| | - Oscar Lin
- Department of Pathology, Hematopathology Service, Memorial Sloan Kettering Cancer Center
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Yeow M, Ching AH, Guillon C, Alperovich M. Breast implant capsule-associated squamous cell carcinoma: A systematic review and individual patient data meta-analysis. J Plast Reconstr Aesthet Surg 2023; 86:24-32. [PMID: 37666057 DOI: 10.1016/j.bjps.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/13/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION New concerns have been raised by the US Food and Drug Administration regarding breast implant capsule-associated squamous cell carcinoma (BICA-SCC) but very little is known about this emerging topic. To gain a better understanding of the disease, a systematic review and individual patient data meta-analysis of patients with BICA-SCC were performed. METHODS PubMed, Embase, and Cochrane were searched from inception to 26th February 2023 for studies including patients with BICA-SCC. Individual patient data were extracted and pooled. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS A total of 16 studies reported 19 patients with BICA-SCC, commonly presented with swelling (84.2%), pain (73.7%), and erythema (21.1%). The median age at SCC diagnosis was 52.0 (interquartile range [IQR] 46.0-60.0) years. The median time from breast augmentation to SCC diagnosis was 20.0 (IQR 15.0-35.0) years. The majority of patients (68.4%) were found to have extracapsular spread at SCC diagnosis. All patients with breast implants in situ underwent implant removal with at least 60.0% of patients undergoing capsulectomy. The mean follow-up period was 17.6 months with 1-year overall survival of 80.8% and 1-year disease-free survival of 53.0%. CONCLUSION While rare, surgeons should counsel patients on the risks of malignancy including BICA-SCC before breast implantation and consider the possibility of BICA-SCC when treating patients with late-onset peri-implant changes. A centralized registry is needed to better understand and improve outcomes in patients with BICA-SCC.
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Affiliation(s)
- Marcus Yeow
- Department of Plastic, Reconstructive and Aesthetics Surgery, Singapore General Hospital, Singapore
| | | | - Christelle Guillon
- Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, National University Hospital, Singapore
| | - Michael Alperovich
- Division of Plastic Surgery, Yale School of Medicine, New Haven, CT, USA.
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Rosenberg K, McGillen P, Zanfagnin V, Lee S, Janaki N, Raicu A, Jayachandran P, Bian S, Yenikomshian H, Sener SF. Invasive squamous cell carcinoma of the breast associated with breast augmentation implant capsule. J Surg Oncol 2023; 128:495-501. [PMID: 37260104 DOI: 10.1002/jso.27364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/02/2023]
Abstract
Primary squamous cell carcinoma (SCC) of the breast is rare, representing less than 0.1% of all breast cancers. To date, there have been 20 reported cases of SCC associated with breast augmentation, usually in patients with long-standing implants. A patient is reported here with primary squamous carcinoma of the breast associated with textured saline implants. Due to the paucity of cases, there is limited information on the incidence and management of implant-associated SCC of the breast.
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Affiliation(s)
- Katherine Rosenberg
- Departments of Radiology, and the Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
| | - Patrick McGillen
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Valentina Zanfagnin
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Pathology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Sandy Lee
- Departments of Radiology, and the Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
| | - Nafiseh Janaki
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Pathology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Andreea Raicu
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Priya Jayachandran
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Medicine, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Shelly Bian
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Radiation Oncology, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Haig Yenikomshian
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Stephen F Sener
- Los Angeles General Medical Center (formerly LAC), Los Angeles, California, USA
- Keck School of Medicine of USC, Surgery, and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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12
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Möllhoff N, Ehrl D, Fuchs B, Frank K, Alt V, Mayr D, Braig D, Giunta RE, Hagen C. [Breast implant-associated squamous cell carcinoma: a systematic literature review]. HANDCHIR MIKROCHIR P 2023; 55:268-277. [PMID: 37473774 DOI: 10.1055/a-2108-9111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and the ASPS published a safety communication on BIA-SCC in 2022, with a first case report of BIA-SCC having been published in the 1990s. This manuscript summarises the current scientific data on this rare tumour entity. MATERIAL AND METHODS This systematic literature review from two independent databases includes all publications of cases with histopathologically confirmed BIA-SCC. Data extraction included study design, demographic data, implant information and details regarding diagnosis and treatment. RESULTS Nineteen cases of BIA-SCC with a mean age of 57±10 years were reported in 16 publications. In most cases, the indication was aesthetic augmentation (n=13). Both silicone (n=11) and saline (n=7) implants with different surfaces (smooth n=3, textured n=3, polyurethane n=1) were used. Symptoms such as unilateral swelling (n=18), pain (n=14) and erythema (n=5) occurred on an average of 23±9 years after implantation. Imaging showed fluid collection (n=8) or a tumour mass (n=4) around the breast implant. The most common surgical treatment was explantation with capsulectomy. Metastasis was described in 6 cases. CONCLUSIONS BIA-SCC is a malignant tumour entity associated with breast implant capsules. Based on current low-quality data (level of evidence class V), no definitive conclusion regarding correlation and causality of SCC in patients with breast implants can be drawn. There is an urgent need for national and international breast implant and breast cancer registries to obtain valid data on the incidence, pathogenesis and clinical presentation of rare tumour entities.
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Affiliation(s)
- Nicholas Möllhoff
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Denis Ehrl
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Benedikt Fuchs
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Konstantin Frank
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
- Ocean Clinic, Marbella, Spain
| | - Verena Alt
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, München, Deutschland
| | - David Braig
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
- Klinik für Plastische und Handchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Riccardo E Giunta
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
| | - Christine Hagen
- Abteilung für Hand-, Plastische- und Ästhetische Chirurgie, Klinikum der Universität München, LMU München, Deutschland
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13
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Glasberg SB, Sommers CA, McClure GT. Breast Implant-associated Squamous Cell Carcinoma: Initial Review and Early Recommendations. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5072. [PMID: 37325375 PMCID: PMC10266515 DOI: 10.1097/gox.0000000000005072] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/02/2023] [Indexed: 06/17/2023]
Abstract
The purpose of this study is to identify and describe all published cases of breast implant-associated squamous cell carcinoma (BIA-SCC) to gain a greater understanding of the incidence, presentation, diagnosis, treatment, and prognosis and to support development of recommendations that promote prompt diagnosis and management in clinical practice. Methods A scoping review of PubMed and social media sites was performed in August and September 2022 to identify published cases of SCC arising in the breast capsule. No limits were set on search results. Additional data review was begun on deidentified cases reported directly to American Society of Plastic Surgeons. Results Twelve articles met inclusion criteria and reported data on 16 total cases. Mean age of patients was 55.56 years (range, 40-81 years). Mean duration from initial implant placement to presentation was 23.56 years (range, 11-40 years). Cases occurred with silicone, saline, textured, and smooth implants. At the time of case publication or reporting, seven patients were alive, five were deceased and/or presumed deceased, and four were unreported. Conclusions BIA-SCC seems to be a rare complication of breast implantation that can result in significant morbidity and mortality. Physicians should be aware of the presentation of BIA-SCC to promote prompt diagnosis and treatment. BIA-SCC should be discussed with all patients considering breast implantation as part of the informed-consent process.
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Affiliation(s)
- Scot B. Glasberg
- From the Cosmetic and Reconstructive Plastic Surgery, New York, N.Y
| | | | - Gina T. McClure
- American Society of Plastic Surgeons, Arlington Heights, Ill
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14
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von Fritschen U, Kremer T, Prantl L, Fricke A. Breast Implant-Associated Tumors. Geburtshilfe Frauenheilkd 2023; 83:686-693. [PMID: 37614684 PMCID: PMC10444514 DOI: 10.1055/a-2073-9534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/13/2023] [Indexed: 08/25/2023] Open
Abstract
In addition to anaplastic large T-cell lymphomas (BIA-ALCL), other implant-related tumors have been described for some years. Squamous cell carcinoma (SSC) and B-cell lymphomas occurred in very rare cases. The unexplained pathogenesis as well as the unclear individual risk profile is an ongoing source of uncertainty for patients and physicians. The pathogenesis of the tumors is still largely not understood. While BIA-ALCL occurs more frequently with textured breast implants, other tumors were also observed with smooth implants and at other implant sites. Multiple potential mechanisms are discussed. It is suspected that the etiology of a chronic inflammatory response and subsequently immunostimulation is multifactorial and appears to play a key role in the malignant transformation. Since there are currently no sufficiently valid data for a specific risk assessment, this must be done with caution. This article presents the incidence, pathogenesis, as well as the level of evidence according to the current state of knowledge, and evaluates and discusses the current literature.
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Affiliation(s)
- Uwe von Fritschen
- Department of Plastic- and Aesthetic Surgery, Helios Klinik Emil von Behring, Berlin, Germany
| | - Thomas Kremer
- Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum St. Georg, Dresden, Germany
| | - Lukas Prantl
- Abteilung für Plastische-, Hand- und Rekonstruktive Chirurgie, Universität Regensburg, Regensburg, Germany
| | - Alba Fricke
- Department of Plastic- and Aesthetic Surgery, Helios Klinik Emil von Behring, Berlin, Germany
- Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Medical Faculty of the University of Freiburg, Freiburg, Germany
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