11 - Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): diagnosis and management

Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a distinct type of T-cell lymphoma involving the capsule or effusion surrounding a breast implant that can present in patients receiving either reconstructive or cosmetic breast implants. BIA-ALCL presents in two-thirds of cases as a delayed (>1 year) periprosthetic fluid collection, and as a capsular mass in one-third of cases. One in eight patients will present with lymphadenopathy. Optimal screening tools include ultrasound and, if indeterminate, then magnetic resonance imaging (MRI). Suspicious fluid collections or capsular masses undergo directed fine-needle aspiration, and diagnosis should be made prior to surgical intervention. Positron emission tomography (PET)/computerized tomography (CT) scan is performed after confirmation of diagnosis as part of a systemic workup of disease progression and is also performed prior to any surgical procedure, as the efficacy of this imaging modality is compromised by a recent surgical intervention. Treatment has progressed in recent years and most commonly includes implant removal and total resection of any associated tumor including capsule, mass, and involved lymph nodes. Anti-CD30 immunotherapy is reserved for advanced disease or surgically unresectable tumors. The role of adjunctive treatments such as chemotherapy, chest wall radiation, and stem cell transplant may also be considered in advanced disease. Further research is warranted to determine potential malignant drivers, disease progression, and optimal treatment strategies in advanced disease.