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Breast Implant-Associated Anaplastic Large-Cell Lymphoma in Brazil: What Are We Missing?
Anne K Groth1, Mark W Clemens1, Ruth Graf1
1From the Plastic Surgery and Microsurgery Department, Erasto Gaertner Hospital; Department of Plastic Surgery, University of Texas M. D. Anderson Cancer Center; Medical Pathology Departament, Federal University of Parana; Pieta Medical Center; Pathology Center and Flow Cytometry Laboratory, Nossa Senhora das Graças Hospital; CETAC-Centro de Diagnóstico por Imagem; Brazilian College of Radiology, DAPI-Diagnóstico Avançado por Imagem; Sírio Libanês Hospital; and AC Camargo Hospital.
Background:
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) has been diagnosed in more than 1000 patients in more than 30 countries, although only a few cases have been reported in Latin America and the Caribbean to date. As the second-largest global market for breast implants with a predominance of textured-surface implants, Brazil is a major global market for cosmetic augmentations, making it unlikely that cases of BIA-ALCL are actually scarce.
Methods:
A local and voluntary registry of patients with BIA-ALCL was initiated in 2018. All patients diagnosed with BIA-ALCL were confirmed by the World Health Organization criteria. Implant characteristics, disease symptoms, treatment, and oncologic outcomes were assessed.
Results:
Fourteen cases of BIA-ALCL in a Brazilian population were identified in the Paraná state. Disease-specific diagnostic tests were omitted before surgical intervention in 50 percent of patients. With additional cases from a literature review, the treatment and outcomes of 29 cases of BIA-ALCL in Brazil were assessed.
Conclusions:
Compared with other populations, these initial observations suggest that awareness of the disease by the local breast surgery community remains low and that a number of cases may remain undiagnosed. Lack of preoperative diagnostic testing compromises disease treatment, oncologic outcomes, and both short- and long-term surveillance.
