Anaplastic Large-Cell Lymphoma in Women With Breast Implants
Anaplastic Large-Cell Lymphoma in Women With Breast Implants
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DOI：
10.1001/jama.2008.585
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发表时间：
2008-11-05
影响因子：
120.7
通讯作者：
van Leeuwen, Flora E.
中科院分区：
文献类型：
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作者：
de Jong, Daphne;Vasmel, Wies L. E.;van Leeuwen, Flora E.
最近，我们发现了2例因美容原因放置的硅胶乳房假体纤维囊内酪氨酸激酶（ALK）阴性的间变性大T细胞淋巴瘤（ALCL）患者。文献中也报道过类似的病例。虽然已经推测使用乳房假体的患者发生ALCL的风险增加，但迄今为止尚未进行任何研究。目的探讨乳房假体是否与ALCL风险相关。设计通过以人群为基础的全国病理数据库，对1990年至2006年间在荷兰诊断为乳腺淋巴瘤的所有患者进行了搜索。随后，我们进行了一项单独匹配的病例对照研究。采用条件logistic回归分析来估计与乳房假体相关的ALCL的相对风险。背景和患者在登记中确定了11例乳腺ALCL患者。对于每一例乳腺ALCL患者，我们选择1至5例乳腺其他淋巴瘤的对照，年龄和诊断年份相匹配。对于所有病例和对照组（n= 35），获得病理和临床信息，特别强调乳房假体的存在。乳房植入物与乳房ALCL之间的关系。结果1994 ~ 2006年间确诊的11例乳腺ALCL患者中位年龄为40岁（范围24 ~ 68岁）。其中5例患者在诊断前1至23年放置双侧硅胶乳房假体。所有人都因美观原因接受了义肢。35例符合条件的对照患者淋巴瘤分类为12例弥漫性大B细胞淋巴瘤，包括1例富T细胞B细胞淋巴瘤；5例伯基特淋巴瘤；粘膜相关淋巴组织型淋巴瘤10例；滤泡性淋巴瘤3例；3例外周T细胞淋巴瘤；惰性B细胞淋巴瘤2例，未分类。35例对照患者中有1例在诊断为淋巴瘤之前进行了乳房植入。ALCL与乳房假体相关的优势比为18.2（95%可信区间为2.1- 156.8）。结论：这些初步研究结果表明硅胶乳房假体与ALCL之间存在关联，尽管由于乳房ALCL的罕见发生，绝对风险极低（荷兰17年内有11例）。这些发现需要在其他研究中得到证实。
Context Recently, we identified 2 patients with anaplastic large T- cell lymphoma ( ALCL) negative for tyrosine kinase anaplastic lymphoma kinase ( ALK- negative) in the fibrous capsule of silicone breast prostheses, placed for cosmetic reasons. Similar cases have been reported in the literature. Although an increased risk of ALCL in patients with breast prostheses has been speculated, no studies have been conducted so far.Objective To determine whether ALCL risk is associated with breast prostheses.Design A search for all patients with lymphoma in the breast diagnosed in the Netherlands between 1990 and 2006 was performed through the population- based nationwide pathology database. Subsequently, we performed an individually matched case- control study. Conditional logistic regression analysis was performed to estimate the relative risk of ALCL associated with breast prostheses.Setting and Patients Eleven patients with breast ALCL were identified in the registry. For each case patient with ALCL in the breast, we selected 1 to 5 controls with other lymphomas in the breast, matched on age and year of diagnosis. For all cases and controls ( n= 35), pathological and clinical information was obtained with special emphasis on the presence of a breast prosthesis.Main Outcome Measure Association between breast implants and ALCL of the breast.Results The 11 patients with ALCL of the breast were diagnosed between 1994 and 2006 at a median age of 40 years ( range, 24- 68 years). In 5 of these patients, bilateral silicone breast prostheses had been placed 1 to 23 years before diagnosis. All received prostheses for cosmetic reasons. Lymphoma classes of 35 eligible control patients were 12 diffuse large B- cell lymphomas, including 1 T- cell rich B- cell lymphoma; 5 Burkitt lymphomas; 10 mucosa- associated lymphoid tissue - type lymphoma; 3 follicular lymphomas; 3 peripheral T- cell lymphomas; and 2 indolent B- cell lymphomas, unclassified. One of 35 control patients had a breast implant placed before diagnosis of lymphoma. The odds ratio for ALCL associated with breast prostheses was 18.2 ( 95% confidence interval, 2.1- 156.8).Conclusions These preliminary findings suggest an association between silicone breast prostheses and ALCL, although the absolute risk is exceedingly low due to the rare occurrence of ALCL of the breast ( 11 cases in the Netherlands in 17 years). These findings require confirmation in other studies.