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Update in Radiology
Uncommon complications of breast prostheses
Complicaciones infrecuentes de las prótesis de mama
N. Sánchez Rubio
Corresponding author
nsrnansaru@gmail.com

Corresponding author.
, B. Lannegrand Menéndez, M. Duque Muñoz, M. Montes Fernández, M.J. Ciudad Fernández
Servicio de Radiodiagnóstico, Hospital Clínico Universitario San Carlos, Madrid, Spain
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or late&#44; when they occur months or years following the operation&#46; The main early complications include infection and periprosthetic collections&#44; and the main late complications include rupture and capsular contracture&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recently&#44; more uncommon late adverse effects have been reported&#44; some of greater significance&#44; such as breast implant-associated anaplastic large cell lymphoma &#40;BIA-ALCL&#41;&#44; breast fibromatosis associated with implants&#44; formation of granulomas secondary to silicone in the fibrous capsule&#44; and lymphadenopathy in patients with implants&#44; which in certain cases may represent a diagnostic dilemma&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Common complications associated with breast implants have been widely studied and are known to all radiologists&#46; This article conducts a review of uncommon pathology associated with breast implants&#44; with a focus on radiological findings and on the clinical and radiological management of said pathology for a proper differential diagnosis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Predictably&#44; the prevalence of these complications will increase as a result of increased use of breast implants&#59; therefore&#44; knowledge and suitable management thereof are important&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Late infection</span><p id="par0025" class="elsevierStylePara elsevierViewall">Infections in the recent post-operative period are among the most common complications&#44; with an incidence of approximately 1&#46;7&#37;&#46; However&#44; late infections &#40;months or years following surgery&#41; are an uncommon complication with an incidence of approximately 0&#46;8&#37; and are usually secondary to a systemic infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;5&#8211;7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The incidence of infection is even greater in patients with post-mastectomy reconstruction&#44; mainly with immediate reconstruction&#46;<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">5&#44;8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It usually presents with fever&#44; pain&#44; erythema and inflammation&#46; The most commonly found pathogens are those located on the skin surface&#44; such as <span class="elsevierStyleItalic">Staphylococcus aureus</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;5&#44;8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">If there is no improvement with antibiotic treatment&#44; explantation is recommended&#46; Explantation is also recommended in cases of fungal infection or if there are signs of systemic infection&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Hypoechoic collections that may have echogenic content are found on ultrasound&#46; Ultrasound serves as a guide for percutaneous fluid aspiration&#44; which allows for cytology testing&#44; immunohistochemistry testing and culture for a proper differential diagnosis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Radiological findings on magnetic resonance imaging &#40;MRI&#41; are the presence of a periprosthetic collection&#44; breast oedema and skin thickening<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;5&#44;7&#8211;9</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Lymphadenopathy</span><p id="par0055" class="elsevierStylePara elsevierViewall">Normally&#44; 75&#37; of lymphatic drainage of the breast occurs through the homolateral axillary lymph nodes&#44; and the other 25&#37; occurs through the internal mammary chain lymph nodes&#44; the contralateral breast and the inferior phrenic lymph nodes&#46; This drainage may become abnormal following lymphadenectomy or sentinel lymph node biopsy&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In patients with breast reconstruction with prostheses&#44; enlarged lymph nodes secondary to a non-specific inflammatory reaction or a reaction to a foreign body due to migration of silicone to the lymph nodes may be found in the axillary region or in the internal mammary lymph node chains&#46; It usually occurs six to ten years following implantation&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">4&#44;10&#44;11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">These lymphadenopathies may present intense fluorodeoxyglucose uptake on positron emission tomography&#47;computed tomography &#40;PET&#47;CT&#41; and therefore represent a diagnostic dilemma in patients with a history of cancer<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">4&#44;10</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Some studies have reported percentages of lymphadenopathy in the internal mammary lymph node chains close to 30&#37; in patients with breast surgery and reconstruction with prostheses&#44; some with uptake on PET&#47;CT&#44; although with very low positive predictive values for malignancy&#59; therefore&#44; in the absence of other data arousing suspicion of relapse&#44; it might be managed conservatively by means of radiological follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Late seroma</span><p id="par0075" class="elsevierStylePara elsevierViewall">Late seroma is a rare complication&#44; defined as any periprosthetic collection that occurs after the year following surgery&#46; Its exact incidence is unknown&#44; although approximate figures of 0&#46;5&#37;&#8211;1&#46;84&#37; are reported&#44; and it is most commonly associated with textured and polyurethane implants&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">12&#8211;15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Its pathophysiology is unknown&#46; It may include mechanical factors such as trauma and synovial metaplasia secondary to microtrauma&#44; and non-mechanical factors such as clinical and subclinical infection&#44; inflammation and lymphoproliferative processes&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">12&#44;16</span></a> However&#44; in most cases&#44; no cause is found&#59; these are deemed idiopathic&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">14</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">On ultrasound and MRI it presents as a periprosthetic collection that may be associated with fibrous capsule thickening &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">It is necessary to rule out infection and malignancy by means of ultrasound-guided aspiration of the periprosthetic fluid&#44; which should be sent for culture and cytology in which cell composition&#44; cell morphology and percentage of CD30&#43; cells are assessed&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">15&#8211;17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Treatment is conservative&#44; and even if cultures are negative&#44; the possibility of subclinical infection should be considered&#46; If a seroma is resistant to treatment&#44; explantation of the prostheses and capsulectomy are recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">12&#44;15&#44;16</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Silicone-induced granulomas</span><p id="par0100" class="elsevierStylePara elsevierViewall">One recently reported complication is formation of masses on the periprosthetic fibrous capsule in patients with intact implants as a result of an inflammatory response to silicone&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">All types of implants&#44; even the most modern&#44; have demonstrated filtration of silicone particles that&#44; when they come into contact with the fibrous capsule&#44; induce a type 2 inflammatory response with increased IgE and IgG levels<span class="elsevierStyleInf">1</span> and chronic activation of T lymphocytes with consequent granuloma formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#44;19</span></a> This immune response will be mild when there is a predominance of giant cells and more aggressive when there is a greater lymphocyte component&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">18</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The intracapsular space has limited vascularisation&#59; therefore&#44; in early phases&#44; when the fibrous capsule is intact&#44; the granuloma is found to be located in the intracapsular space and this is a limited condition with a good prognosis&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Extracapsular granuloma occurs when the mass invades the fibrous capsule and spreads to the adjacent tissue&#46; Exposure to the intracapsular content may cause a more striking &#8211; even systemic &#8211; immune reaction&#44; with the possibility of finding regional lymphadenopathy with silicone infiltration&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#44;20</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Clinically&#44; granulomas present with signs of capsular contracture such as stiffness and pain in the affected breast&#46; As associated findings&#44; patients may present arthralgia&#44; pruritus and asthenia&#44; commonly reported symptoms in the autoimmune syndrome induced by adjuvants such as silicone&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#8211;22</span></a> In addition&#44; there may be periods of spontaneous remission or remission with anti-inflammatory agents&#47;corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Granulomas may be associated with a haematoma or intracapsular seroma&#44; enhancement of the fibrous capsule to different degrees or capsular contracture&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Prevalences of intracapsular granulomas of 27&#37; have been reported&#59; of these&#44; 12&#37; were associated with a seroma and 3&#37; showed signs of extracapsular involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Histologically&#44; they are formed by extracellular or intracellular silicone&#44; histiocytes&#44; chronic granulomatous inflammatory infiltrate with multi-nucleated giant cells and mixed lymphocytic infiltrate with no atypia<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Radiological findings of intracapsular granuloma&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">A heterogeneous intracapsular mass may be visualised on ultrasound&#59; this may be associated with snowstorm artefact due to free silicone&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a></p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">MRI is the best diagnostic technique for its assessment&#44; since it also assesses implant integrity&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">The intracapsular mass shows a hypersignal in T2-enhanced sequences and a hyposignal in T1-enhanced sequences&#46; It may exert a mass effect on the implant<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#8211;20&#44;23</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Late dynamic sequences &#40;more than 4<span class="elsevierStyleHsp" style=""></span>min&#41; must be performed following administration of intravenous contrast in order to distinguish between intracapsular seroma&#47;haematoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#44;23</span></a> It will present gradual enhancement with type I curves&#44; sometimes with hypervascular nodular areas inside the mass&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">The black-drop sign may be identified&#59; this consists of a focus of marked hyposignal at the interface between the implant covering and the granuloma in the dynamic study&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#44;20</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">PET&#47;CT is usually negative<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p></li></ul></p><p id="par0175" class="elsevierStylePara elsevierViewall">Radiological findings of extracapsular granuloma&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">A mass with peripheral vascularisation and areas with snowstorm artefact may be identified on ultrasound<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">20&#44;23</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">A mass with infiltration of the fibrous capsule will be visualised on MRI&#46; Following administration of intravenous contrast&#44; due to the lack of barrier represented by the fibrous capsule&#44; it may present enhancement in early phases&#46; There may be axillary siliconomas<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">Uptake by the mass as well as uptake by the axillary and mammary lymph nodes may be identified on PET&#47;CT&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">20</span></a></p></li></ul></p><p id="par0195" class="elsevierStylePara elsevierViewall">The differential diagnosis of granulomas includes mainly seroma and late haematoma&#44; for which administration of intravenous contrast will be necessary&#44; as well as BIA-ALCL&#44; which in a third of cases may present as a periprosthetic mass&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#8211;20&#44;23</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Treatment consists of prosthesis explantation and capsulectomy&#46;<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">18&#44;20</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">It is advisable to avoid percutaneous biopsies when an intracapsular granuloma is suspected due to the risk of rupture of the barrier that provides the fibrous capsule which could lead to a systemic reaction&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">19&#44;23</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Breast fibromatosis</span><p id="par0210" class="elsevierStylePara elsevierViewall">Desmoid tumours or fibromatoses comprise a rare type of benign stromal tumour that may be classified based on their location as extra-abdominal&#44; abdominal or intra-abdominal&#46;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">24&#8211;26</span></a> Breast fibromatosis is an extremely uncommon disease accounting for approximately 4&#37; of extra-abdominal desmoid tumours and 0&#46;2&#37; of all breast tumours&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#8211;30</span></a> Cases associated with breast implants are even rarer&#44; with few published studies in the specialised literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;31&#44;32</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">Breast fibromatosis may originate in the breast parenchyma&#44; the aponeurosis of the pectoral muscle and probably in the periprosthetic capsule&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;27&#8211;29</span></a></p><p id="par0220" class="elsevierStylePara elsevierViewall">They present infiltrative and aggressive local growth with a high percentage of relapse&#44; but not a tendency to metastasise&#46;<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">27</span></a> Due to this growth&#44; they may simulate malignancy&#44; especially in patients with a history of prior breast surgery&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Their pathogenesis is unknown&#46; However&#44; most desmoid tumours occur sporadically&#44; being associated in up to 85&#37; of these cases with a mutation in the beta-catenin gene&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">31</span></a> Cases associated with Gardner syndrome&#44; trauma&#44; surgery or augmentation mammoplasty have been reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">25&#44;26&#44;31</span></a> Increased tumour volume has been observed during pregnancy&#44; suggesting a hormonal&#44; mainly oestrogenic&#44; influence&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">25&#44;26&#44;32</span></a></p><p id="par0230" class="elsevierStylePara elsevierViewall">It was recently suggested that the presence of breast implants may be a risk factor&#44; although a clear causal relationship has not yet been confirmed&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">29</span></a> More cases have been reported in association with silicone implants versus saline implants&#44; although this may be due to the greater prevalence of silicone implants&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;28</span></a> Most cases have occurred two to three years after surgery&#44; and in all reported cases the implants were found to be intact&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;28</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Clinically&#44; they usually present as a single&#44; firm and painless palpable mass with rapid growth&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;28&#44;32</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Histologically&#44; they are composed of small groups of spindle-shaped cells and fibroblasts separated by variable amounts of collagen&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">26&#44;28</span></a> They usually present nuclear positivity for beta-catenin and negativity for oestrogen and progesterone receptors&#46;<a class="elsevierStyleCrossRefs" href="#bib0400"><span class="elsevierStyleSup">28&#44;30</span></a></p><p id="par0245" class="elsevierStylePara elsevierViewall">Radiological findings are non-specific&#59; therefore&#44; a biopsy must be performed to diagnose them&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">Breast fibromatosis presents an appearance provoking suspicion of malignancy on both mammography and ultrasound&#46; However&#44; cases associated with breast implants usually show a more benign appearance&#44; with relatively well-defined margins despite their tendency towards local infiltration<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;27&#44;28</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46;</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0255" class="elsevierStylePara elsevierViewall">MRI is the imaging technique of choice to evaluate both tumour spread and the relationship of the tumour to adjacent structures&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">25&#44;27&#44;31&#44;33&#44;34</span></a> Masses are observed which may present well-defined margins &#40;49&#37;&#8211;54&#37;&#41; or irregular and infiltrative margins &#40;46&#37;&#8211;51&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">31</span></a></p><p id="par0260" class="elsevierStylePara elsevierViewall">Lesion signal and enhancement kinetics vary by amount of collagen and degree of cellularity&#46;<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">25&#44;27&#44;31</span></a> Three histological stages are reported depending on collagen content and cellularity which influence the signal in T2-enhanced sequences&#46; In initial stages&#44; they present a lesser amount of collagen and greater cellularity&#44; which translates to high signal in T2&#44; as well as lesser cellularity and a greater amount of collagen in end stages with low signal in T2-enhanced sequences&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">31</span></a> They often present gradual kinetics&#44; although cases of plateau or washout kinetics in late phases have also been reported<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">25&#44;27&#44;28&#44;34</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0265" class="elsevierStylePara elsevierViewall">Fibromatoses usually show in 62&#37;&#8211;91&#37; hypointense areas inside the lesion in all sequences due to the presence of collagen fibres with limited cellularity<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;31</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0035">Fig&#46; 7</a>&#41;&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">Other signs that may be visualised on different imaging techniques&#44; although essentially on MRI&#44; are the fascial tail sign&#44; which consists of linear extensions across the fascial planes&#44; and the split-fat sign&#44; which consists of a fine halo of fat surrounding the lesion<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">27&#44;31&#44;35</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#fig0035">Figs&#46; 7 and 8</a>&#41;&#46;</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><p id="par0275" class="elsevierStylePara elsevierViewall">PET&#47;CT may aid in guiding the biopsy&#44; evaluating the aggressiveness of the lesion and diagnosing disease recurrences and progression&#46;<a class="elsevierStyleCrossRefs" href="#bib0440"><span class="elsevierStyleSup">36&#8211;38</span></a> Desmoid tumours are usually hypermetabolic&#44; although there may be intralesional variability depending on the percentage of cells and the collagen content of the lesion<a class="elsevierStyleCrossRefs" href="#bib0445"><span class="elsevierStyleSup">37&#44;38</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0040">Fig&#46; 8</a>&#41;&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">Management and treatment of these lesions is debated due to the few existing cases&#46; Whenever possible&#44; the treatment of choice will consist of wide local excision with negative margins in an attempt to decease their recurrence&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;26&#44;28</span></a> Radiotherapy is usually the treatment pursued when the disease is unresectable or associated with surgery if negative margins cannot be achieved&#46;<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">26&#44;28</span></a></p><p id="par0285" class="elsevierStylePara elsevierViewall">Drug treatment is usually reserved for patients with recurrences and includes non-steroidal anti-inflammatory drugs&#44; interferon&#44; hormone therapy and cytotoxic agents with different degrees of success&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">32</span></a> Although desmoid tumours usually do not express oestrogen receptors&#44; anti-oestrogenic agents &#40;tamoxifen&#41; have demonstrated disease management in some cases &#40;from disease stabilisation to cases of complete remission&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">26</span></a> Tamoxifen&#39;s mechanism of action is not clear&#44; but it appears to be independent of oestrogen receptor expression&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">26</span></a></p><p id="par0290" class="elsevierStylePara elsevierViewall">Clinical and radiological follow-up are necessary due to the high rate of relapse&#44; especially in the first three years&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">39</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Anaplastic large cell lymphoma</span><p id="par0295" class="elsevierStylePara elsevierViewall">Primary breast lymphoma &#40;PBL&#41; is a rare tumour accounting for 0&#46;5&#37; of cases of breast cancer and 2&#37; of cases of extranodal lymphoma&#46; PBL originates in the periductal and perilobar breast lymphoid tissue&#46; Most PBLs derive from B cells&#59; tumours with T cell phenotypes are rare &#40;less than 6&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">19</span></a></p><p id="par0300" class="elsevierStylePara elsevierViewall">Anaplastic large cell lymphoma is a peripheral T cell lymphoma that accounts for 2&#37;&#8211;3&#37; of all non-Hodgkin lymphomas&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">19&#44;40&#44;41</span></a> It may affect a wide variety of tissues&#44; including breast tissue&#46; There are two variants of anaplastic large cell lymphoma&#58; one is systemic&#44; with lymphadenopathy and extranodal involvement&#59; the other is cutaneous&#46; In 2016&#44; the World Health Organization &#40;WHO&#41; recognised BIA-ALCL as a discrete entity&#44; diagnosed in the capsule or the periprosthetic fluid and rarely infiltrating the breast parenchyma&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">41&#44;42</span></a> This is a CD30&#43;&#44; ALK-negative tumour with a better prognosis than systemic forms of anaplastic large cell lymphoma&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">19&#44;40&#8211;45</span></a></p><p id="par0305" class="elsevierStylePara elsevierViewall">The first case of BIA-ALCL was reported in 1997&#44; and since then the number of cases has gradually increased&#44; probably due to growing numbers of breast implants and greater knowledge of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;40&#44;43</span></a> However&#44; the true relative and absolute risk of lymphoma in women with implants is unknown&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">46</span></a></p><p id="par0310" class="elsevierStylePara elsevierViewall">It is usually diagnosed three to seven years following surgery&#44; with a mean of five years following mammoplasty&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">19</span></a> Cases have been reported in both mammoplasty due to aesthetic reasons&#44; such as breast reconstruction&#44; and in transgender patients&#46; Most cases have been reported in textured implants&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;40&#44;41&#44;44&#44;45</span></a></p><p id="par0315" class="elsevierStylePara elsevierViewall">At present&#44; there is insufficient evidence that different types of implant fillers &#40;saline and silicone&#41; are associated with greater risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;47</span></a> In addition&#44; some reported cases have occurred in families with a high risk of breast cancer&#59; therefore&#44; there may be an increased risk in patients with a BRCA mutation&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">46</span></a></p><p id="par0320" class="elsevierStylePara elsevierViewall">Their pathogenesis is unknown&#46; The following have been reported as potential risk factors&#58; capsular contracture&#44; subclinical infection on the surface of the implant &#40;biofilm&#41;&#44; repeated capsular trauma&#44; an immune response to silicone components&#44; a genetic predisposition and an autoimmune mechanism&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">1&#44;40&#44;43&#44;44</span></a></p><p id="par0325" class="elsevierStylePara elsevierViewall">Notable among the main theories of the aetiopathogenesis of this activated T cell monoclonal neoplasm is the theory that it is due to chronic lymphocyte stimulation in predisposed individuals&#44; secondary to bacterial contamination on the surface of the implant&#44; or due to chronic inflammation caused by the silicone or polyurethane from which the implant is made&#46;<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">19&#44;42&#44;43&#44;45&#44;47</span></a> In addition&#44; textured implants seem to cause a more marked local T cell-mediated response than implants with a smooth surface&#59; hence&#44; they may carry a greater risk of lymphoma&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">45</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">There are two main forms of presentation&#46; The more common is as late-onset periprosthetic seroma&#44; which usually corresponds to localised disease&#46; The other is a mass in which the tumour grows on or through the capsule&#44; with or without an associated seroma&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;43&#44;45</span></a></p><p id="par0335" class="elsevierStylePara elsevierViewall">Cases with lymphatic involvement with no breast mass&#44; as well as cases in the non-explanted residual fibrous capsule near the prosthesis&#44; have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">48</span></a> Other&#44; less common presentations are pain&#44; erythema&#44; skin lesions&#44; fever and systemic signs&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;42&#44;43</span></a></p><p id="par0340" class="elsevierStylePara elsevierViewall">Therefore&#44; the development of a periprosthetic seroma of late onset is a suspicious sign that should be evaluated by ultrasound with fine needle aspiration biopsy &#40;FNAB&#41; of the fluid for microbiology&#44; cytology and flow cytometry testing &#40;including CD30 markers&#41;&#46; When it presents as a mass or axillary lymphadenopathy&#44; that mass or lymphadenopathy must be biopsied and the presence of CD30 markers must be assessed&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">45</span></a></p><p id="par0345" class="elsevierStylePara elsevierViewall">Histological diagnosis consists of demonstration of T lymphocytes of atypical morphology &#40;very large&#44; aberrant cells&#41; with strong CD30 expression and negativity for ALK&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Lymphomas presenting in an initial stage usually have an excellent prognosis only with explantation of the prostheses and the fibrous capsule&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">When there is infiltration&#44; management must be more aggressive&#44; with removal of the mass with negative margins and of the lymphadenopathy&#46; Adjuvant treatment should be considered&#44; as higher relapse rates and mortality rates of approximately 40&#37; in two years have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">40</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">Neither sentinel lymph node biopsy nor lymphadenectomy is indicated as neither has been shown to decrease recurrence rates<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;43&#44;45</span></a>&#46;</p><p id="par0365" class="elsevierStylePara elsevierViewall">Involvement of the contralateral capsule has been shown in 4&#46;6&#37; of cases&#59; therefore&#44; bilateral explantation is recommended&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;45</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">Whenever BIA-ALCL is diagnosed&#44; a suitable extension study must be conducted by PET&#47;CT and bone marrow biopsy to rule out systemic forms of anaplastic large cell lymphoma&#46;</p><p id="par0375" class="elsevierStylePara elsevierViewall">A specific TNM classification was recently proposed &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;45&#44;49</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Radiological diagnosis of BIA-ALCL</span><p id="par0380" class="elsevierStylePara elsevierViewall">There are no specific radiological findings&#46;</p><p id="par0385" class="elsevierStylePara elsevierViewall">Mammography exhibits a sensitivity of 73&#37; and a specificity of 50&#37; for detecting abnormalities&#44; some subtle such as capsule contour thickening or irregularity&#44; but it does not distinguish between masses and seromas&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;50</span></a></p><p id="par0390" class="elsevierStylePara elsevierViewall">Ultrasound and MRI are the best imaging techniques for their diagnosis&#44; since they are the most sensitive techniques for detecting periprosthetic fluid&#46; The most sensitive technique in mass detection is PET&#47;CT &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">50</span></a></p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0395" class="elsevierStylePara elsevierViewall">Ultrasound is the first imaging test that must be performed in cases of clinical suspicion&#44; in order to assess the presence of a seroma&#44; a mass or lymphadenopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">49</span></a> It is the most cost-effective technique&#44; and furthermore serves as a guide for seroma drainage<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;50&#44;51</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0045">Fig&#46; 9</a>&#41;&#46;</p><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0400" class="elsevierStylePara elsevierViewall">Breast MRI is recommended when ultrasound findings are inconclusive&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">49</span></a> MRI assesses the presence of a seroma&#44; a mass or lymphadenopathy&#46; It also assesses implant integrity and associated findings such as capsule thickening and enhancement<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">50</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#fig0045">Figs&#46; 9 and 10</a>&#41;&#46;</p><elsevierMultimedia ident="fig0050"></elsevierMultimedia><p id="par0405" class="elsevierStylePara elsevierViewall">Confirmed cases of BIA-ALCL are staged with PET&#47;CT&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">49</span></a> PET&#47;CT may identify diffuse or focal periprosthetic uptake&#44; hypermetabolic masses and lymphadenopathy&#46; However&#44; no standardised uptake values &#40;SUVs&#41; have been established for the diagnosis of a seroma or a mass in BIA-ALCL<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">40&#44;43&#44;50&#44;52</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0050">Fig&#46; 10</a>&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Prognosis and follow-up</span><p id="par0410" class="elsevierStylePara elsevierViewall">Relapse rates following complete surgery are approximately 6&#37;&#8211;11&#37; in the first year&#46; Some series have reported local recurrence rates of approximately 36&#37; and distant recurrence rates of 64&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">40</span></a></p><p id="par0415" class="elsevierStylePara elsevierViewall">If excision was complete with no residual disease&#44; follow-up every three to six months for two years with subsequent follow-up depending on clinical findings is recommended&#46; It is recommended that a CT or a PET&#47;CT scan be done every six months for two years with subsequent follow-up depending on the patient&#39;s clinical picture&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">44&#44;45&#44;49</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conclusion</span><p id="par0420" class="elsevierStylePara elsevierViewall">Breast implants can be associated with a number of complications&#44; some of which&#44; such as rupture&#44; are widely known to radiologists&#46; However&#44; recently&#44; more uncommon complications have been reported&#44; and some of them&#44; such as BIA-ALCL&#44; are more significant&#46;</p><p id="par0425" class="elsevierStylePara elsevierViewall">An increase in the prevalence of these more uncommon conditions can be predicted as a result of the growing use of breast implants&#46; The clinician must be knowledgeable about them in order to be able to suitably diagnose and treat them&#46; Of particular importance is proper management of late-onset periprosthetic seroma&#44; the main sign of BIA-ALCL&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Authorship</span><p id="par0430" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">1&#46;</span><p id="par0435" class="elsevierStylePara elsevierViewall">Responsible for study integrity&#58; NSR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">2&#46;</span><p id="par0440" class="elsevierStylePara elsevierViewall">Study conception&#58; NSR and MJCF&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">3&#46;</span><p id="par0445" class="elsevierStylePara elsevierViewall">Study design&#58; NSR&#44; MJCF&#44; MMF&#44; BLM and MDM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">4&#46;</span><p id="par0450" class="elsevierStylePara elsevierViewall">Data acquisition&#58; NSR&#44; MMF&#44; MJCF&#44; MDM and BLM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">5&#46;</span><p id="par0455" class="elsevierStylePara elsevierViewall">Data analysis and interpretation&#58; NSR&#44; MJCF&#44; MMF&#44; BLM and MDM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">6&#46;</span><p id="par0460" class="elsevierStylePara elsevierViewall">Statistical processing&#58; N&#47;A&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">7&#46;</span><p id="par0465" class="elsevierStylePara elsevierViewall">Literature search&#58; NSR&#44; MDM and BLM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">8&#46;</span><p id="par0470" class="elsevierStylePara elsevierViewall">Drafting of the article&#58; NSR&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">9&#46;</span><p id="par0475" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually significant contributions&#58; NSR&#44; MJCF&#44; MMF&#44; BLM and MDM&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">10&#46;</span><p id="par0480" class="elsevierStylePara elsevierViewall">Approval of the final version&#58; NSR&#44; MMF&#44; MJCF&#44; BLM and MDM&#46;</p></li></ul></p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:16 [
        0 => array:3 [
          "identificador" => "xres1380149"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1267492"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1380148"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1267493"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Late infection"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Lymphadenopathy"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Late seroma"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Silicone-induced granulomas"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Breast fibromatosis"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Anaplastic large cell lymphoma"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Radiological diagnosis of BIA-ALCL"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Prognosis and follow-up"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusion"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Authorship"
        ]
        15 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-09-25"
    "fechaAceptado" => "2020-01-31"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1267492"
          "palabras" => array:10 [
            0 => "Breast implants"
            1 => "Breast cancer"
            2 => "Breast surgery"
            3 => "Late seroma"
            4 => "Late infection"
            5 => "Fibrous capsule granuloma"
            6 => "Breast fibromatosis"
            7 => "Internal mammary chain adenopathies"
            8 => "Large cell anaplastic lymphoma"
            9 => "Magnetic resonance imaging"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1267493"
          "palabras" => array:10 [
            0 => "Implantes mamarios"
            1 => "C&#225;ncer de mama"
            2 => "Cirug&#237;a de mama"
            3 => "Seroma tard&#237;o"
            4 => "Infecci&#243;n tard&#237;a"
            5 => "Granulomas de la c&#225;psula fibrosa"
            6 => "Fibromatosis mamaria"
            7 => "Adenopat&#237;as de la cadena mamaria interna"
            8 => "Linfoma anapl&#225;sico de c&#233;lulas grandes"
            9 => "Resonancia magn&#233;tica de mama"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Breast implants are associated with well-known common complications that have been widely studied&#44; such as rupture and capsular contraction&#46; However&#44; the increasingly growing number of patients with breast implants has led to the increased likelihood of coming across less common complications&#59; these include seromas or late infection&#59; adenopathies in the internal mammary chain&#59; granulomas in the capsule of the implant&#44; which in some cases can extend beyond the fibrous capsule&#59; desmoid tumours associated with the implants&#59; and breast implant-associated large cell anaplastic lymphoma&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This article aims to review the main uncommon complications associated with breast implants and to describe and illustrate their findings in different imaging techniques&#46; Proper management of these complications is important&#59; this is especially true of late seroma and the diagnosis of breast implant-associated large cell anaplastic lymphoma for their repercussions&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los implantes mamarios se asocian a complicaciones frecuentes ampliamente conocidas y estudiadas como la rotura y la contractura capsular&#46; Sin embargo&#44; debido al n&#250;mero cada vez mayor de pacientes portadoras de implantes mamarios&#44; podemos encontrarnos con patolog&#237;a m&#225;s infrecuente como la presencia de seroma o infecci&#243;n tard&#237;a&#44; adenopat&#237;as en la cadena mamaria interna&#44; granulomas en la c&#225;psula del implante &#8211;que en algunos casos pueden extenderse m&#225;s all&#225; de la c&#225;psula fibrosa&#8211;&#44; tumores desmoides asociados a los implantes y el linfoma anapl&#225;sico de c&#233;lulas grandes asociado a implantes mamarios&#46; El objetivo de este art&#237;culo es revisar las principales complicaciones infrecuentes asociadas a los implantes mamarios y sus hallazgos radiol&#243;gicos en las diferentes t&#233;cnicas&#46; Es importante un correcto manejo de esta patolog&#237;a&#44; principalmente del seroma tard&#237;o&#44; para diagnosticar precozmente el linfoma anapl&#225;sico de c&#233;lulas grandes por su mayor transcendencia&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; S&#225;nchez Rubio N&#44; Lannegrand Men&#233;ndez B&#44; Duque Mu&#241;oz M&#44; Montes Fern&#225;ndez M&#44; Ciudad Fern&#225;ndez MJ&#46; Complicaciones infrecuentes de las pr&#243;tesis de mama&#46; Radiolog&#237;a&#46; 2020&#46; <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.rx.2020.01.008">https&#58;&#47;&#47;doi&#46;org&#47;10&#46;1016&#47;j&#46;rx&#46;2020&#46;01&#46;008</span></p>"
      ]
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        "etiqueta" => "Figure 1"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Late infection&#46; &#40;A&#41; A heterogeneous periprosthetic collection &#40;&#42;&#41; with the presence of septa &#40;arrow&#41; was identified on ultrasound&#46; &#40;B&#41; Axial STIR&#46; &#40;C&#41; Diffusion&#46; &#40;D&#41; Sagittal T2&#46; &#40;E&#41; Axial T1 following administration of intravenous contrast&#46; Moderate periprosthetic seroma &#40;&#42;&#41; with intact implant&#46; It presented restricted diffusion and diffuse enhancement of the fibrous capsule &#40;arrow&#41;&#46; &#40;F&#41; Cell block &#40;200&#215; H&#38;E staining&#41; consisting of polymorphonuclear leukocytes in a proteinaceous fluid&#46;</p>"
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Lymphadenopathy in the internal mammary lymph node chain&#46; A patient with a history of left mastectomy due to breast cancer and right prophylactic mastectomy with reconstruction with bilateral prostheses&#46; The follow-up PET&#47;CT scan identified the appearance of lymphadenopathy in the left internal mammary lymph node chain with uptake arousing suspicion of relapse &#40;arrow&#41;&#46; Fine needle aspiration biopsy was performed but did not identify any signs of relapse&#46;</p>"
        ]
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      2 => array:7 [
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        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Late seroma&#46; &#40;A&#41; Craniocaudal mammography of the right breast showing a modest increase in density adjacent to the inner aspect of the prosthesis&#44; with no abnormality on its contour &#40;arrow&#41;&#46; &#40;B&#41; On ultrasound it corresponded to a small amount of anechogenic fluid &#40;&#42;&#41;&#46; &#40;C&#41; STIR axial MRI&#46; &#40;D&#41; Sagittal T1 following administration of intravenous contrast&#46; Small periprosthetic seroma &#40;&#42;&#41; with implant integrity&#46; It was associated with diffuse modest enhancement of the fibrous capsule &#40;arrow&#41;&#46; Evacuating fine needle aspiration biopsy of the periprosthetic fluid was performed and no cause could be identified &#40;idiopathic seroma&#41;&#46;</p>"
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      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1801
            "Ancho" => 2508
            "Tamanyo" => 413381
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Intracapsular granuloma&#46; &#40;A&#41; Axial T2 MRI&#46; &#40;B&#41; Axial T1 following administration of intravenous contrast&#46; Hyperintense mass in T2-enhanced sequences &#40;arrow&#41; of intracapsular location posterior to the prosthesis in the left breast&#46; Intact fibrous capsule&#46; Following administration of intravenous contrast&#44; thickening and enhancement of the posterior aspect of the fibrous capsule &#40;dashed arrow&#41; adjacent to the mass without clear enhancement of the mass was identified&#46; &#40;C&#41; Diffuse modest uptake by the posterior aspect of the fibrous capsule &#40;dashed arrow&#41; with no uptake by the mass was identified on PET&#47;CT&#46; &#40;D&#41; 200&#215; H&#38;E staining of the fibrous capsule showing cystic spaces containing pale extracellular material consistent with silicone&#44; surrounded by vacuolated histiocytes&#44; lymphocytes and multi-nucleated giant cells&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1602
            "Ancho" => 2500
            "Tamanyo" => 390766
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Extracapsular granuloma&#46; &#40;A&#41; Ultrasound showing a large heterogeneous mass in contact with the breast implant which was found to be displaced &#40;&#42;&#41;&#46; &#40;B&#8211;D&#41; Axial and sagittal T2&#46; Heterogeneous intracapsular mass leading to a mass effect on the retroglandular implant &#40;&#42;&#41;&#46; Loss of the integrity of the fibrous capsule with incipient spread towards the adjacent parenchyma was identified &#40;solid arrow&#41;&#46; The normal capsule was visualised as a hypointense line surrounding the mass &#40;dashed arrow&#41;&#46; There was lymphadenopathy with signs of silicone infiltration &#40;arrow in D&#41;&#46; &#40;E and F&#41; Perfusion map and kinetic curve showing the mass with areas of high perfusion and kinetic curves with rapid initial uptake and late-phase washout &#40;type 3&#41;&#46;</p>"
        ]
      ]
      5 => array:7 [
        "identificador" => "fig0030"
        "etiqueta" => "Figure 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 791
            "Ancho" => 2508
            "Tamanyo" => 169191
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Breast fibromatosis&#46; &#40;A and B&#41; Craniocaudal and mediolateral oblique mammography of the right breast&#46; Mass with well-defined borders in the outer quadrants of the breast &#40;arrow&#41;&#46; The mass was found to be in close contact with the outer and posterior aspect of the prosthesis with effacement of the contour of the prosthesis and anterior displacement thereof&#46; &#40;C and D&#41; On ultrasound it corresponded to a large heterogeneous mass with relatively well-defined borders in close contact with the prosthesis&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figure 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr7.jpeg"
            "Alto" => 1660
            "Ancho" => 2508
            "Tamanyo" => 418789
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Breast fibromatosis &#40;same case as in <a class="elsevierStyleCrossRef" href="#fig0030">Fig&#46; 6</a>&#41;&#46; &#40;A&#41; Axial T1&#46; A large isointense mass&#44; located in close contact with and posterior to the right implant with anterior displacement of the prosthesis and a significant increase in breast volume&#46; The split fat sign&#44; consisting of a fine halo of fat surrounding the lesion&#44; was identified &#40;white arrow&#41;&#46; &#40;B&#41; Sagittal T2 showing the hyperintense mass with small hypointense areas inside the lesion &#40;orange arrow&#41;&#46; &#40;C and D&#41; MRI following administration of intravenous contrast&#46; The mass presented significant contrast uptake with the presence of small hypointense areas &#40;orange arrow&#41; corresponding to the presence of collagen fibres with limited cellularity&#46; It presented local infiltration with spread through the intercostal space towards the thorax &#40;white arrow&#41;&#46; &#40;E and F&#41; Perfusion map and kinetic curve showing increased perfusion with a plateau &#40;type 2&#41; kinetic curve&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "fig0040"
        "etiqueta" => "Figure 8"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr8.jpeg"
            "Alto" => 1860
            "Ancho" => 2508
            "Tamanyo" => 431374
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Breast fibromatosis&#46; &#40;A and B&#41; Ultrasound&#58; well-defined hypoechogenic retropectoral mass in contact with the prosthesis extending through the intercostal space &#40;dashed arrow&#41;&#46; Fascial tail sign &#40;solid arrow in &#40;A&#41;&#41; consisting of linear extensions towards the lateral margins&#46; &#40;C&#41; PET&#47;CT&#58; the mass was slightly hypermetabolic &#40;solid arrow&#41;&#46; &#40;D&#41; Pathology &#40;200&#215; H&#38;E staining&#41;&#58; fusiform cell bundles in a collagen-rich stroma with scattered lymphocytes and extravasated red blood cells&#46;</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "fig0045"
        "etiqueta" => "Figure 9"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr9.jpeg"
            "Alto" => 1786
            "Ancho" => 2508
            "Tamanyo" => 359658
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">BIA-ALCL&#46; &#40;A&#41; Ultrasound showing modest periprosthetic seroma in the left breast &#40;&#42;&#41;&#46; &#40;B&#41; Axial T2 MRI&#46; &#40;C&#41; Diffusion&#46; &#40;D&#41; Axial T1 following administration of contrast&#46; Modest periprosthetic seroma &#40;&#42;&#41; with implant integrity&#46; The seroma presented restricted diffusion &#40;red arrow&#41; and mild diffuse enhancement of the fibrous capsule &#40;white arrow&#41;&#46; Fine needle aspiration biopsy of the periprosthetic fluid was performed and confirmed the diagnosis&#46;</p>"
        ]
      ]
      9 => array:7 [
        "identificador" => "fig0050"
        "etiqueta" => "Figure 10"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr10.jpeg"
            "Alto" => 910
            "Ancho" => 2508
            "Tamanyo" => 144820
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">BIA-ALCL&#46; &#40;A&#41; Axial T2 MRI identifying a periprosthetic seroma with implant integrity&#46; Evacuating fine needle aspiration biopsy was performed and confirmed BIA-ALCL&#46; On PET&#47;CT following seroma evacuation modest hyperuptake of the anterior aspect of the periprosthetic capsule &#40;arrow&#41; was identified&#46;</p>"
        ]
      ]
      10 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CNB&#58; core needle biopsy&#59; FNAB&#58; fine needle aspiration biopsy&#59; MRI&#58; magnetic resonance imaging&#59; PET&#47;CT&#58; positron emission tomography&#47;computed tomography&#59; US&#58; ultrasound&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time period following surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Clinical signs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Radiological findings&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Common&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perioperative period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perioperative period&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever&#44; pain and inflammation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periprosthetic collection with or without content&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antibiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Periprosthetic collections &#40;haematoma&#44; seroma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pain and increased breast volume&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Haematoma&#58; heterogeneous collection&#46; Seroma&#58; anechogenic collection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Percutaneous drainage depending on signs and symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Late&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Capsular contracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After 3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Inflamed&#44; deformed and painful breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">The diagnosis is clinical&#46; Increase in the anterior&#8211;posterior diameter of the implant&#44; thickening and calcifications of the capsule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prosthesis explantation and capsulectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Prosthetic rupture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Greater probability after 10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No symptoms&#44; or deformity&#44; pain and oedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intracapsular</span>&#58; US&#58; stepladder sign&#46; MRI&#58; teardrop or keyhole sign&#44; subcapsular line sign or linguine sign<span class="elsevierStyleItalic">Extracapsular</span>&#58; spread of silicone through the capsule&#46; US&#58; &#8220;snowstorm&#8221; sign&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prosthesis explantation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Uncommon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Late&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Months or years following surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Fever&#44; pain&#44; erythema and inflammation&#46; Secondary to systemic infection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periprosthetic collection with or without content<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>oedema and skin thickening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Antibiotics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Late seroma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After one year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Increased breast volume and pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Periprosthetic collection<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>capsule thickening&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Granuloma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After 2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Signs of capsular contracture&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Intracapsular</span>&#58; heterogeneous mass with high signal in T2 sequences&#46; Gradual late &#40;&#62;4<span class="elsevierStyleHsp" style=""></span>min&#41; enhancement&#46; Negative PET&#47;CT<span class="elsevierStyleItalic">Extracapsular</span>&#58; capsule-infiltrating mass&#46; Early enhancement&#46; Axillary lymphadenopathy<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>positive PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prosthesis explantation and capsulectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Breast fibromatosis associated with implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After 2 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Firm&#44; painless mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Infiltrating mass with relatively well-defined marginsMRI&#58; signal in T2 and variable enhancement kinetics depending on stage&#46; Hypointense areas in all sequencesPET&#47;CT&#58; slight uptake&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wide local excision with negative margins&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; BIA-ALCL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After 3 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sudden increase in breast volume&#43; freq&#46; of textured implants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#47;3 periprosthetic seroma1&#47;3 capsule-affecting mass<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>lymphadenopathy&#46; PET&#47;CT&#58; periprosthetic uptake or hypermetabolic mass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Capsulectomy and prosthesis explantation&#46; Adjuvant treatment if advanced disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8226; Lymphadenopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">After 6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Depending on size and location&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Larger lymphadenopathy with or without uptake on PET&#47;CT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Conservative CNB&#47;FNAB if relapse is suspected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2369720.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Summary of complications associated with breast implants&#46;</p>"
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      ]
      11 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">BIA-ALCL&#58; breast implant-associated anaplastic large cell lymphoma&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TNM Description</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">T&#58; Tumour extentT1&#58; Confined to seromaT2&#58; Early capsule infiltrationT3&#58; Cell aggregates infiltrating the capsuleT4&#58; Infiltrates beyond the capsule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">N&#58; Lymph nodes</span>N0&#58; No lymph node involvementN1&#58; One regional lymph node &#40;&#43;&#41;N2&#58; Multiple regional lymph nodes &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">M&#58; Metastasis</span>M0&#58; No distant spreadM1&#58; Spread to other organs&#47;distant sites&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TNM STAGING</span>IA&#58; T1 N0 M0IB&#58; T2 N0 M0IC&#58; T3 N0 M0IIA&#58; T4 N0 M0IIB&#58; T1&#8211;3 N1 M0III&#58; T4 N1&#8211;2 M0IV&#58; Any T Any N M1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2369721.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">National Comprehensive Cancer Network BIA-ALCL TNM classification &#40;2019&#41;&#46;</p>"
        ]
      ]
      12 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CT&#58; computed tomography&#59; MRI&#58; magnetic resonance imaging&#59; PET&#47;CT&#58; positron emission tomography&#47;computed tomography&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seroma</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mass</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensitivity&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specificity&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensitivity&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specificity&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Article information
ISSN: 21735107
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos