Brustimplantat assoziiertes Plattenepithelkarzinom (BIA-SCC) – eine systematische Literaturübersicht

 

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Zusammenfassung

Hintergrund Das Brustimplantat assoziierte Plattenepithelkarzinom (BIA-SCC) wird als eigenständige, von der Implantatkapsel ausgehende, maligne Tumorentität diskutiert. Die FDA und die ASPS veröffentlichten 2022 eine Mitteilung zum BIA-SCC, wobei bereits in den 1990er Jahren erstmalig ein Fallbericht von BIA-SCC erschien. Das Manuskript fasst die aktuelle wissenschaftliche Datenlage zu dieser seltenen Tumorentität zusammen.

Material und Methoden Die Literaturübersicht basiert auf einer systematischen Datenabfrage aus zwei unabhängigen Datenbanken und schließt alle Veröffentlichungen von Fällen mit histopathologisch gesichertem BIA-SCC ein. Die Datenextraktion umfasste Studiendesign, demografische Daten, Informationen zu den Implantaten, sowie Details zur Diagnostik und Therapie.

Ergebnisse Die Recherche ergab 19 BIA-SCC-Fälle in 16 Publikationen, mit einem Durchschnittsalter von 57±10 Jahren. Die Indikation zur Verwendung eines Brustimplantates war in den meisten Fällen eine ästhetische Brustvergrößerung (n=13). Sowohl silikon- (n=11), als auch kochsalzhaltige (n=7) Implantate mit unterschiedlichen Oberflächen (glatt n=3, texturiert n=3, polyurethan n=1) wurden eingesetzt. Symptome wie einseitige Schwellung (n=18), Schmerzen (n=14) und Erythem (n=5) traten im Durchschnitt 23±9 Jahre nach Implantation auf. Die Bildgebung zeigte einen Flüssigkeitssaum (n=8) oder eine Tumormasse (n=4) um das Brustimplantat. Die häufigste chirurgische Therapie war die Explantation mit Kapsulektomie. In 6 Fällen wurde eine Metastasierung beschrieben.

Schlussfolgerung Das BIA-SCC ist eine maligne Tumorentität, die mit Brustimplantaten und der Kapsel um Brustimplantate in Verbindung gebracht wird. Zum aktuellen Zeitpunkt kann aufgrund der Datenlage aus Studien mit niedrigem Evidenzgrad V keine endgültige Aussage bezüglich Korrelation und Kausalität des SCC in Patient*innen mit Brustimplantaten erfolgen. Es besteht dringender Bedarf nationaler und internationaler Brustimplantat- und Brustkrebsregister, um valide Daten zu Inzidenz, Pathogenese, und Klinik seltener Tumorentitäten zu erlangen.

Abstract

Background Breast implant-associated squamous cell carcinoma (BIA-SCC) is being discussed as a distinct malignant tumour entity originating from the implant capsule. The FDA and the ASPS published a safety communication on BIA-SCC in 2022, with a first case report of BIA-SCC having been published in the 1990s. This manuscript summarises the current scientific data on this rare tumour entity.

Material and Methods This systematic literature review from two independent databases includes all publications of cases with histopathologically confirmed BIA-SCC. Data extraction included study design, demographic data, implant information and details regarding diagnosis and treatment.

Results Nineteen cases of BIA-SCC with a mean age of 57±10 years were reported in 16 publications. In most cases, the indication was aesthetic augmentation (n=13). Both silicone (n=11) and saline (n=7) implants with different surfaces (smooth n=3, textured n=3, polyurethane n=1) were used. Symptoms such as unilateral swelling (n=18), pain (n=14) and erythema (n=5) occurred on an average of 23±9 years after implantation. Imaging showed fluid collection (n=8) or a tumour mass (n=4) around the breast implant. The most common surgical treatment was explantation with capsulectomy. Metastasis was described in 6 cases.

Conclusions BIA-SCC is a malignant tumour entity associated with breast implant capsules. Based on current low-quality data (level of evidence class V), no definitive conclusion regarding correlation and causality of SCC in patients with breast implants can be drawn. There is an urgent need for national and international breast implant and breast cancer registries to obtain valid data on the incidence, pathogenesis and clinical presentation of rare tumour entities.

Publication History

Received: 02 April 2023

Accepted: 24 May 2023

Article published online:
20 July 2023

© 2023. Thieme. All rights reserved.

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