From the MD Anderson Cancer Center, University of Texas.
Washington University School of Medicine.
Plast Reconstr Surg. 2024 Sep 1;154(3):473-483. doi: 10.1097/PRS.0000000000011370. Epub 2024 Feb 22.
In the absence of high-quality evidence, there is a need for guidelines and multidisciplinary consensus recommendations on breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL). The purpose of this expert consensus conference was to evaluate the existing evidence regarding the diagnosis and management of BIA-ALCL caused by textured implants. This article aims to provide evidence-based recommendations regarding the management and prevention of BIA-ALCL.
A comprehensive search was conducted in the MEDLINE, Cochrane Library, and Embase databases, and supplemented by manual searches of relevant English-language articles and "related articles" sections. Studies focusing on breast surgery and lymphoma associated with breast implants were included for analysis. Meta-analyses were performed and reviewed by experts selected by the American Association of Plastic Surgeons using a Delphi consensus method.
A total of 840 articles published between January of 2011 and January of 2023 were initially identified and screened. The full text of 188 articles was assessed. An additional 43 articles were excluded for focus, and 145 articles were included in the synthesis of results, with 105 of them being case reports or case series. The analysis encompassed a comprehensive examination of the selected articles to determine the incidence, risk factors, clinical presentation, diagnostic approaches, and treatment modalities related to BIA-ALCL.
Plastic surgeons should be aware of the elevated risks by implant surface type, implement appropriate patient surveillance, and follow the recommendations outlined in this statement to ensure patient safety and optimize outcomes. Ongoing research on the pathogenesis, genetic drivers, and preventative and prophylactic measures for BIA-ALCL is crucial for improving patient care.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, V.
由于缺乏高质量的证据，我们需要制定指南和多学科共识建议，以指导处理与乳房植入物相关的间变性大细胞淋巴瘤（BIA-ALCL）。本次专家共识会议的目的是评估目前关于诊断和处理与粗糙表面乳房植入物相关的 BIA-ALCL 的现有证据。本文旨在提供关于 BIA-ALCL 的管理和预防的循证建议。
在 MEDLINE、Cochrane 图书馆和 Embase 数据库中进行了全面检索，并补充了对相关英文文章和“相关文章”部分的手动检索。纳入了分析的研究包括乳房手术和与乳房植入物相关的淋巴瘤。采用美国整形外科学会专家选择的 Delphi 共识方法进行了荟萃分析和综述。
共确定并筛选了 2011 年 1 月至 2023 年 1 月期间发表的 840 篇文章。评估了 188 篇文章的全文。另外排除了 43 篇文章，综合了结果，其中 105 篇为病例报告或病例系列。分析全面检查了所选文章，以确定 BIA-ALCL 相关的发病率、危险因素、临床表现、诊断方法和治疗方式。
整形医生应意识到植入物表面类型的风险增加，应实施适当的患者监测，并遵循本声明中的建议，以确保患者安全并优化结果。BIA-ALCL 的发病机制、遗传驱动因素以及预防和预防性措施的持续研究对于改善患者护理至关重要。
临床问题/证据水平：风险，V。
