Current risk of breast implant-associated anaplastic large cell lymphoma: a systematic review of epidemiological studies.
Current risk of breast implant-associated anaplastic large cell lymphoma: a systematic review of epidemiological studies.
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DOI：
10.21037/abs-20-96
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发表时间：
2021-01-01
期刊：
影响因子：
--
通讯作者：
Clemens, Mark W
中科院分区：
文献类型：
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作者：
Lynch, Evan B;DeCoster, Ryan C;Clemens, Mark W
最近的流行病学研究试图准确确定乳房植入体相关间变性大细胞淋巴瘤（BIA-ALCL）的风险。然而，由于报道的广泛差异，以前出版的作品的比较是困难的。我们系统地回顾了流行病学，以更好地定义BIA-ALCL的当前风险。在此，我们报告了全球流行病学，重点是美国乳房植入体人群，同时评估了光滑表面器械的肿瘤安全性。在当前手稿中，对PubMed和其他科学数据库以及灰色文献进行了系统性综述，用于BIA-ALCL的流行病学研究。使用分析性和描述性流行病学，我们使用标准化方法估计BIA-ALCL的累积发病率和发病率。报告了植入物和患者特定水平的累积发生率。美国市场中使用毛面植入物的患者特定累积风险范围为1.79/1，000（1：559）至2.82/1，000（1：355）。Allergan毛面器械的植入物特定风险范围为1：602-871至1：8,500，而市售Mentor Siltex植入物的风险为1：50000。没有流行病学研究或监管机构报告仅使用光面器械发生BIA-ALCL的病例。因此，随着Allergan毛面乳房植入体的移除，本研究表明BIA-ALCL的流行病学知识存在巨大差距，包括美国市场上市售毛面乳房植入体的当前风险。尽管BIA-ALCL的风险较低，但外科医生在考虑将毛面乳房器械用于美容或重建目的时应格外谨慎。
Recent epidemiological studies have attempted to accurately determine the risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). However, comparisons of previously published works are difficult due to widespread variations in reporting. We systematically review the epidemiology in order to better define the current risk of BIA-ALCL. Herein, we report the global epidemiology with an emphasis on the U.S. breast implant population while simultaneously assessing the oncologic safety of smooth-surface devices. In the current manuscript, a systematic review of PubMed and other scientific databases, as well as the grey literature, was conducted for epidemiologic studies on BIA-ALCL. Using analytical and descriptive epidemiology, we estimated the cumulative incidence and incidence rate of BIA-ALCL using a standardized approach. Cumulative incidence was reported at implant and patient-specific levels. The patient-specific cumulative risk within the U.S. market ranges from 1.79 per 1,000 (1:559) to 2.82 per 1,000 (1:355) patients with a textured implant. The implant-specific risk of Allergan textured devices ranges from 1:602-871 to 1:8,500, while the risk of commercially available Mentor Siltex implants is 1:50,000. No epidemiological study or regulatory agency reported a case of BIA-ALCL occurring exclusively with a smooth device. As such, with the removal of Allergan textured breast devices, this study demonstrates substantial gaps in the epidemiological knowledge of BIA-ALCL, including the current risk of commercially available textured breast implants in the U.S. market. Although the risk of BIA-ALCL is low, surgeons should exercise extreme caution when considering the use of a textured breast device for cosmetic or reconstructive purposes.