Place and objectives of ultrasound examination of the mammary glands after augmentation mammoplasty with silicone endoprostheses in the instrumental algorithm of patients with suspected BIA-ALCL (literature review)

Abstract

In the 90s of the last century, the first isolated cases of the occurrence of T-cell non-Hodgkin's lymphoma of the breast after augmentation mammoplasty with silicone endoprostheses were identified. For many years, this disease was considered very rare and was not associated with the presence of implants. In the future, the number of patients with this pathology began to increase. In 2012, the FDA identified an association between anaplastic large cell T lymphoma and breast implants and introduced the term Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL), which is now recognized as a new disease by the WHO. Active study of BIA-ALCL continues today. An increase in the estimated risk of developing this severe complication of plastic surgery was noted.Purpose: to present a literature review of materials covering the problems associated with the most severe complication of augmentation mammoplasty – BIA-ALCL; to determine the place and tasks of ultrasound in the proposed diagnostic instrumental algorithm for patients with suspected BIA-ALCL based on a set of ultrasound criteria.Materials and methods. The analysis of literary sources on the topic "BIA-ALCL" was carried out. With the accumulation of experience in the diagnosis and treatment of patients with BIA-ALCL, the number of papers presenting clinical observations on this topic has increased in the available literature. From 2013 to December 2022, PUBmed found 324 search results in the BIA-ALCL section. The vast majority of English-language papers – about 200 – were published in 2020 and 2021. Single publications are presented in Russian.Based on world experience in 2016, recommendations for the diagnosis and treatment of patients with BIAALCL were developed and updated in 2019. According to the literature, three criteria have been formulated that should be paid special attention in order not to miss this disease: the accumulation of a significant amount of fluid in the periprosthetic space (occurs in 60% of cases), the presence of additional masses in this fluid (8–24%), and axillary pathological lymphadenopathy (4–12%). Instrumental examination of patients with suspected BIA-ALCL is recommended to begin with ultrasound or MRI. The prevalence of the process is assessed by PET/CT.It is necessary to raise the awareness of doctors and patients about the possibility of developing this complication of plastic surgery, to actively continue the study and search for diagnostic criteria for BIA-ALCL to identify the process in the early stages of the disease.