Additional Risk Factors for Breast Implant–Associated Anaplastic Large Cell Lymphoma

Abstract

Discussion | Both the updated ACS-Calculator and actual NSQIP data find that risk in these medically complex surgical case scenarios more closely approximates the mean risk estimates reported by residents than those determined by a previous ACS-Calculator. 1 Although the NSQIP outcomes in actual patients listed in the Table arbitrarily exclude some risk factors, the web tool shows that many different combinations of strong risk factors result in similarly high morbidity and mortality rates. We conclude that high rates of complications can be correctly expected for the scenario patients. Given these findings, we agree that clinicians should not be "shackled" by risk models, 4 and we believe that residents should be educated to supplement, but not replace, their clinical judgment with risk estimation tools.Risk calculators do not provide "true" reference risk, but rather projections, which vary in their applicability to individual patients. The surveyed residents correctly recognized outlier patients who, owing to their acute problems and multiple severe chronic conditions, defy attempts to mathematically estimate their course. Several authors have reported higher observed risk, as found in these scenarios, than that estimated by the ACS-Calculator and other NSQIP calculators for high-risk subgroups. 5,6 Small sample sizes often explain such discrepancies, 6 but clinicians most often consult the ACS-Calculator for samples of 1, their current patient. We therefore suggest that with trivial programming, the ACS-Calculator could be updated to supply actual case numbers and outcomes from the NSQIP database in addition to risk-model estimations. As our web tool demonstrates, seeing real NSQIP complication rates, and whether 10 000 or 2 NSQIP patients share the current patient's risk factor profile, would contextualize the ACS-Calculator's results and inform their meaning for individual patients.

Silicone-Induced Granuloma of Breast Implant Capsule (SIGBIC): Histopathology and Radiological Correlation

“…More recent manuscripts still question whether BIA-ALCL would be a true lymphoma, assuming the possibility that it could be due to an immune response. In this context, a recent article was published which reported spontaneous regression of BIA-ALCL in 2 patients [ 3 , 4 ].…”