Canadian Society for Aesthetic Plastic Surgery 42nd Annual Meeting
Bibliographic record
Abstract
BACkgROUND: Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a newly identified lymphoma arising around breast implants placed for cosmetic or reconstructive indications.Patterns of disease progression and optimal treatment strategies have not been described. METHODS:The literature was reviewed for all published cases of BI-ALCL from 1997 to November 2014, contacted corresponding authors to update clinical follow up, management, and combined data with institutional cases.A novel clinic-pathologic TNM staging system is proposed and was compared to traditional Ann Arbor staging to determine prognostic value for overall survival (OS) and progression free survival (PFS).A Prentice, Williams and Peterson (PWP) model was used to assess treatment effect on progression events.RESULTS: We identified 128 unique cases of BI-ALCL, including 91 previously reported and 37 unreported cases.Pathologic slides were available in 56 patients for pathologic staging.Average follow up was 45 months (30-217 months).The median OS was 13 years, OS rate 93% at 3-years and 89% at 5 years.18 progression events were noted and median PFS was 13 months, with 3-year and 5-year PFS at 79.4%.Total capsulectomy with implant removal (TCIR) prolonged OS (p=0.022) and improved PFS (p=0.014), and the effect of definitive surgery was statistically significant for PFS benefit (HR 0.14 [95%, CI 0.05 to 0.46]; p=0.001).After definitive surgery, patients had 4% of risk of having events by the end of the first year while the rates were 18%, 24% and 60% when patient had radiation, chemotherapy or limited surgery.The PFS was significantly different by Ann Arbor staging (p=0.013) and by the newly proposed clinical staging (p=0.030).CONCLUSIONS: Advanced stage, presence of mass, incomplete resection, and delay in definitive surgical treatment were associated with poor OS and PFS in patients with BI-ALCL.Surgical management with definitive excision and oncologic surveillance is adequate for most patients with BI-ALCL.The role for chemotherapy, targeted immunotherapy, and/or radiation for advanced disease requires further research in larger series.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.415 | 0.123 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".