Breast implant-associated anaplastic large-cell lymphoma - an evolution through the decades: citation analysis of the top fifty most cited articles.

Abstract

Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently discovered malignancy of T-cell type, correlated with the use of silicone breast implants. It has been theorized that the etiology may be linked to bacterial growth and long-term inflammation. The afflicted patient usually presents with breast swelling due to peri-implant fluid accumulation. Currently, the diagnosis is achieved by ultrasound, biopsy and testing for certain biomarkers. Following this, the treatment is achieved by complete surgical excision, or by capsulectomy and exchange with smoother surfaced implants. The aim of this study was to identify and report 50 most cited articles related to the field of BIA--ALCL.

Methods: The Web of Science Citation Index was used to identify 325 articles pertaining to BIA-ALCL. The 50 most cited articles among these were included in this study. The title, author name, journal and year of publication, country and institute of origin, level of evidence (LoE), type of study (clinical or basic), and topic of study (pathophysiology, oncologic management, diagnosis, case report and case series) were recorded.

Results: This study includes articles from the period 1997-2018 with an average citation rate of 65.5. The majority of the top cited articles (36%; N = 18) were found to be case reports, followed by case series (18%; N = 9), systemic reviews (12%; N = 6) and studies focused on the pathophysiology (16%; N = 8), oncologic management (6%; N = 3), databases (6%; N = 3), diagnostics (4%; N = 2) and informed consent (2%; N = 1). The articles were published across 30 journals and originated from 35 institutes. The United States was found to be the country of origin of most of the studies. While none of the articles achieved LoE 1, many were found to have LoE 4 (N = 11) or 5 (N = 19). Most of the articles (N = 42), were clinical research studies.

Conclusion: According to this citation analysis, a large fraction of the existing high impact literature on BIA-ALCL is focused on disease monitoring. Through this study, we hope to present a simple educational tool to better appreciate the research in this relatively young field.