Risk of ALCL After Breast Implant Insertion

In This Article

Abstract and Introduction

Abstract

Purpose: The aim of this study was to determine the odds ratio of anaplastic large-cell lymphoma in late seroma formation.

Methods: In a PubMed search, 415 articles were found using the terms "breast implant AND seroma" (n = 232), "breast implant AND effusion" (n = 42), and "anaplastic large cell lymphoma AND breast (n = 141). Sixty-seven abstracts were read, and 27 full articles were reviewed.

Results: Three articles reported the incidence of late seroma in breast implants, with a total of 75 seromas out of 48,211 implants (0.16%). One article reported 48 cases of non-Hodgkin lymphoma from 43,537 implants (0.11%). Another article reported that 11 patients had anaplastic large-cell lymphoma among 389 primary lymphoma of the breast (2.83%). Two articles reported 143 seromas out of 236 anaplastic large-cell lymphomas (60.59%). The risk of anaplastic large-cell lymphoma was significantly higher in the patients having late seroma than those without seroma (odds ratio = 998.93; 95% confidence interval, 768.90–1297.78; P < .001). The incidence of anaplastic large-cell lymphoma in seroma was calculated by dividing the number of anaplastic large cell lymphomas with seroma (n = 143) by total seroma (N = 11,843), which resulted in an incidence of 1.21%. The expected incidence of anaplastic large-cell lymphoma in seroma was 1.21%.

Conclusion: If late seroma develops after breast implant insertion, ultrasonography-guided aspiration should be performed, with enzyme-linked-immunosorbent serologic assay for CD30.

Introduction

Breast implant–associated anaplastic large-cell lymphoma (ALCL) has recently come to the attention of researchers and clinicians. It most frequently presents as an effusion-associated fibrous capsule surrounding an implant but can present as a mass in some cases.^[1] According to the American Cancer Society, approximately 2% of lymphomas can be classified as ALCL.^[2] Recently, several review articles about ALCL have been published, but very few studies have focused on the association of ALCL with late seroma.^[1,3,4]

The aim of this study was to determine the odds ratio (OR) of late seroma formation for ALCL.

Table 1. Incidence of late seroma in breast implant
Author	Patients with seroma	Breast implants	Incidence (%)
Mazzocchi et al (2010)⁵	8	435	1.84
Bengtson et al (2011)⁶	62	47,208	0.13
Pinchuk and Tymofii (2011)⁷	5	568	0.88
Total	75	48,211	0.16

Table 2. Incidence of non-Hodgkin lymphoma in breast implant and anaplastic large-cell lymphoma in breast lymphoma*
	NHL patients	Breast implants	Incidence (%)
Lipworth et al (2009)⁸	48	43,537	0.11
	ALCL patients	Breast lymphoma	Incidence (%)
de Jong et al (2008)⁹	11	389	2.83

*NHL indicates non-Hodgkin lymphoma; ALCL, anaplastic large-cell lymphoma.

Table 3. Seroma and anaplastic large-cell lymphoma*
Author	Patients with seroma	ALCL implants	Incidence (%)
Hart et al (2014)⁴	39	63	61.90
Brody et al (2015)³⁰	104	173	60.12
Total	143	236	60.59

*ALCL indicates anaplastic large-cell lymphoma.

Table 4. Odds ratio and risk ratio of anaplastic large-cell lymphoma in late seroma*
	ALCL		Total	OR (95% CI)	RR (95% CI)
	+	−
Seroma
+	143	11,700	11,843	998.93 (768.90–1297.78)	986.88 (760.58–1280.53)
−	93	7,600,967	7,601,060
Total	236	7,612,967	7,612,903	P < .001	P < .001

*ALCL indicates anaplastic large-cell lymphoma; OR, odds ratio; CI, confidence interval; RR, relative risk.

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Risk of Anaplastic Large-Cell Lymphoma (ALCL) in Cases of Late Seroma Formation After Breast Implant Insertion

Abstract and Introduction

Abstract

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