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Введение. В 90-е годы прошлого столетия были выявлены первые единичные случаи возникновения Т-клеточной неходжкинской лимфомы молочной железы после увеличивающей маммопластики силиконовыми эндопротезами. В течение многих лет это заболевание считали очень редким и не связывали его развитие с наличием имплантов. В дальнейшем количество пациенток с данной патологией стало увеличиваться. В 2012 г. FDA указало на связь анапластической крупноклеточной Т-лимфомы с установленными эндопротезами молочных желез, и был введен термин Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL), признанный в настоящее время ВОЗ новым заболеванием. Активное изучение BIAALCL продолжается и в наши дни. Отмечен рост предполагаемого риска развития этого тяжелого осложнения пластики.Цель исследования: представить литературный обзор материалов, освещающих проблемы, связанные с наиболее тяжелым осложнением аугментационной маммопластики – BIA-ALCL; определить место и задачи ультразвукового исследования (УЗИ) в предложенном диагностическом инструментальном алгоритме пациенток с подозрением на BIA-ALCL на основе комплекса ультразвуковых критериев.Материал и методы. Проведен анализ литературных источников по теме “BIA-ALCL”. По мере накопления опыта по диагностике и лечению пациентов с BIA-ALCL в доступной литературе увеличивалось количество работ, представляющих клинические наблюдения по данной теме. С 2013 г. по декабрь 2022 г. в PUBmed найдены 324 результата поиска в разделе BIA-ALCL. Подавляющее количество англоязычных работ – около 200 – были опубликованы в 2020 и 2021 гг. Единичные публикации представлены на русском языке.На основе мирового опыта в 2016 г. были разработаны и в 2019 г. обновлены рекомендации по диагностике и лечению пациентов с BIA-ALCL. По данным литературы, сформулированы три критерия, на которые следует особо обращать внимание, чтобы не пропустить данное заболевание: накопление значительного количества жидкости в перипротезном пространстве (встречается в 60% случаев), наличие дополнительных масс в этой жидкости (8–24%) и аксиллярная патологическая лимфаденопатия (4–12%). Инструментальное обследование пациенток с подозрением на BIA-ALCL рекомендовано начинать с УЗИ или МРТ. Распространенность процесса оценивают при ПЭТ/КТ.По мнению медицинского сообщества, необходимо повышать осведомленность врачей и пациентов о возможности развития данного осложнения пластики, активно продолжать изучение и поиск диагностических критериев BIA-ALCL для выявления процесса на ранних стадиях заболевания.
Ключевые слова:
УЗИ, аугментационная маммопластика, Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL), US, augmentation mammoplasty, Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL)
Литература:
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58.Иванова А.Р., Федоров Н.М., Каргапольцева Р.И., Кысыкова Ю.Е., Вьюшкова Д.С. Анапластическая крупноклеточная лимфома у женщин с эндопротезами молочной железы. Научный форум. Сибирь. 2022; 8 (1): 31–33.
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.
Keywords:
УЗИ, аугментационная маммопластика, Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL), US, augmentation mammoplasty, Breast Implant-Associatad Anaplastic Large Cell Lymphoma (BIA-ALCL)