Part 1: Breast implant-associated anaplastic large-cell lymphoma: Systematic review of the current level of evidence on pathogenesis

Abstract

Background. Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a newly defined clinical entity. However, much of the research around this topic is based on prognostic studies with low levels of evidence.

Objective. To conduct a literature review on the pathogenesis of BIA-ALCL. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Based on the grading system for levels of evidence for prognostic studies suggested by Burns et al., each article was graded between 3 and 4.

Results. After articles were removed based on exclusion criteria, 55 remained for review. These included level 5 expert-opinion and bench-research articles (n=39), level 4 case series reports (n=4) and level 3 case control studies and systematic reviews of case control articles (n=12). No level 1 or 2 research articles were found in our search.

Conclusion. Our study describes potential BIA-ALCL risk factors, and provides the level of evidence for the interpretation of recommendations for clinical practice and further study.