Evaluation of the Information Included in the Pathology Request Forms for Breast Tissue Specimens in Patients Submitted to Exchange or Explant of Silicone Breast Implants: Analysis of 251 Patients.

Goals/Purpose: The description of BIA-ALCL, BIA-SCCA and the increase of explantation surgery resulted in an increase of histopathological exams. The objective of this study is to analyze the quality and quantity of data provided by the surgeon upon request form for cytology and histopathological examination in breast surgery involving silicone breast implants removal or exchange

Methods/Technique: From a total of 3304 breast pathology exams, 251 breast implant cases and their pathology requests were studied. The following data from the medical requests were checked and when present were analyzed: gender, age, type of surgery, number of specimens containers sent, laterality, anatomical and spatial location, clinical history, signs and symptoms, previous radiotherapy, previous chemotherapy, diagnostic hypothesis, previous surgeries, type end brand of the breast implant, and reference to previous breast exams.

Results/Complications: The mean age was 43 years old. Laterality (right or left breast) was not mentioned in 16 requests (6,37%). The surgery performed was mentioned in 15,94% requests. The number of containers varies from 1 to 5, with a median of 2. The containers included capsules in 242 cases, 161 as isolated capsule, 27 mammary tissue and capsule in the same specimen, 54 mammary tissues sent in a separate container. Anatomical and spatial location was mentioned in 6,33% cases. The detailed clinical data was included in 19,12%, signs and symptoms 13,94%. Contracture was the only sign mentioned in 64 requests. In 27 forms, lymphoma evaluation was requested. In 15 seroma was mentioned in the clinical history, and from 9 of those, liquid was sent with a request for immunohistochemical and cytology analysis together with the breast-capsule tissue. None of the seromas was punctured preoperatively. None of the requests had any data on implant type or brand. (Table 1)

Conclusion: Our results demonstrate that the amount of information contained in the medical request is minimal. The lack of data of spatial orientation and the fact that most of the breast specimens were send in one container or with the capsule isolated, turn difficult the pathology report. The authors aware the need for a protocol, wide-ranging all types of breast silicone implant disorders to standardize the exam request, the surgical removal of the capsule and the adjacent mammary tissue and the way to send the specimens to the pathologist.