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Breast Implant-associated Anaplastic Large Cell Lymphoma - a Systematic Review with Pooled Analysis.
1Department of Surgery, University of Hong Kong, Hong Kong; Department of Surgery, Queen Mary Hospital, Hong Kong; Department of Surgery, Tung Wah Hospital, Hong Kong.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|August 1, 2020
Summary
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is linked to textured implants and often presents as seroma. Early diagnosis and treatment are crucial for this indolent lymphoma.
Area of Science:
- Oncology
- Medical Devices
- Public Health
Background:
- The association between breast implants and anaplastic large cell lymphoma (BIA-ALCL) has raised public health concerns regarding implant safety.
- BIA-ALCL, first described in 1997, is a rare condition that warrants further investigation into its characteristics and patient outcomes.
Purpose of the Study:
- To conduct a systematic review and pooled analysis of existing data on BIA-ALCL.
- To analyze patient demographics, implant characteristics, clinical presentation, treatment modalities, and outcomes for BIA-ALCL.
Main Methods:
- A systematic literature search was performed, retrieving 674 articles.
- Data from 77 selected articles were extracted, analyzing information from 395 patients diagnosed with BIA-ALCL.
- Pooled analysis was used to identify trends in age, implant texture, time to diagnosis, presenting symptoms, treatment, and recurrence.
Main Results:
- The median age at diagnosis was 52 years, with all identified textured implants associated with BIA-ALCL.
- Seroma was the most common presentation (67.1%), followed by breast mass (20.5%). Patients presenting with breast mass or lymphadenopathy had more disseminated disease.
- Primary surgery, including implant removal and capsulectomy, was common (73.2%). Recurrence was observed in 4.3% of patients, with a median time to first recurrence of 1 year.
Conclusions:
- BIA-ALCL is an indolent disease typically presenting with seroma following breast implant insertion.
- A high index of suspicion is necessary for early diagnosis and effective management of BIA-ALCL.
- While many patients undergo surgical treatment, non-surgical options and reinsertion of implants are also noted, highlighting the complexity of management.
