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Vol. 25, Art. 9 (pp. 143-159)    |    2024       

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Prospects for the application of flow cytometry in the diagnostics of late periprostheс seromas after augmentation mammoplasty

Naumova E.V.1, Mel?nikov D.V.2, Petruchuk V.A.2, Prudnikova D.K.2

1Department of clinical laboratory diagnostics, Russian Medical Academy of Continuous Professional Education, Moscow, Russian Federation
2 I.M. Sechenov First Moscow State Medical University (Sechenovskiy University), Moscow, Russian Federation
Corresponding author: Petruchuk Vera Alekseevna, +7 (926) 465-83-73, E-mail: petruchukvera@yandex.ru

Brief summary

Late periprosthetic seromas occur in 1-2% of cases about 6 months after augmentation mammoplasty surgery. Purpose of the study. To study the immunophenotypic characteristics of the cellular material of various late periprosthetic seromas of the breast by flow cytometry. To evaluate clinical variants of late periprosthetic seromas of the breast depending on the immunophenotypic characteristics of the cellular substrate and to determine the tactics of patient management depending on the cellular composition of late periprosthetic seromas of the breast. Materials and methods. The study involved 25 patients aged 28 to 61 years, median age was 37.5 years. All patients complained of breast discomfort, swelling, and breast enlargement after previous breast augmentation surgery with silicone implants. A total of 33 samples of periprosthetic cellular aspirates from 25 patients were analyzed, including 20 patients after primary augmentation mammoplasty, and 5 patients after breast implant replacement. All patients underwent cellular material sampling of periprosthetic seroma (N=33) and subsequent immunophenotypic analysis by flow cytometry. A comparative characterization of the cellular composition of these samples was carried out. This article presents immunophenotypic characteristics of the cellular composition of late periprosthetic seromas of the breast obtained by flow cytometry, as well as a description of two clinical cases. Results. In 14 samples (42.42%), neutrophil granulocytes (CD45+CD16+CD15+SSChigh) predominated in the amount from 60.9% to 96.4% of all studied cells, which indicates the presence of bacterial inflammation. In 8 samples (24.24%), cellular elements of the macrophage-monocyte system (CD45+CD16-CD15- CD64+CD4+ SSC med) predominated in the amount from 41.7% to 63.9% of all studied cells, which should be considered as ?implant wear? or silicone leakage into the periprosthetic area. In 11 samples (33.33%), cellular elements of the CD45high gate - lymphocytes predominated from 42.5% to 72.4% of all studied cells; in some cases this should be considered as a normal cellular composition of the periprosthetic fluid or an inflammatory reaction, in other cases - as a lymphoproliferative condition. In 2 of 25 patients, cells with an aberrant phenotype were identified: in one case, 20.1% of cells with the CD45lowCD3-CD4+/-CD8-CD5+CD2-/+CD19-CD64-CD71-CD7+/- immunophenotype; in the other case, 24.6% of cells with the CD30+CD3-CD71+/-CD15+/-CD7-CD45+/-SSChigh immunophenotype. Conclusions. Immunophenotyping of cellular samples of late periprosthetic seromas after implant-based breast augmentation allows us to identify cells with an aberrant immunophenotype corresponding to a lymphoproliferative disease. The study allows the detection of a pathological cellular substrate with the CD30+/-CD3-CD71+/-CD15+/-CD7-CD45+/-SSChigh immunophenotype, corresponding to a breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). In addition, flow cytometry helps identify cells of various types (macrophage-monocytic system, granulocytic series, lymphocytes and their subpopulation composition), which enables to predict the patient's further condition, identify possible risks of capsular contracture, suggest the presence of infectious complications, and also assess the need for breast implant replacement.


Key words

flow cytometry, late periprosthetic seroma, augmentation mammoplasty, immunophenotypic analysis

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