- The UK National Co-ordinating Committee of Breast Pathology has issued new, evidence-based recommendations for pathological diagnosis and management of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL).
Why this matters
- BIA-ALCL is a rare, but life-threatening complication of breast implants.
- The current staging system, the Ann Arbor Staging System, has limited prognostic value, so a new one is being suggested.
- Systematic literature review.
- Funding: None disclosed.
- Epidemiology: 518 cases from 25 countries since 1997 have been entered into the American Society of Plastic Surgeons PROFILE registry, with estimated risk of 1-3/million/year.
- Presentation: late onset (8-10 years postimplant) accumulation of seroma fluid, but occasionally as a mass lesion.
- Neoplastic cells are highly atypical, strongly positive for CD30, with 43%-90% also positive for epithelial membrane antigen (EMA), 100% anaplastic lymphoma kinase (ALK)-negative, and CD68 negative.
- Presence of CD30 alone is insufficient for diagnosis.
- Guidelines contain a new pathology algorithm.
- Surgery: removal of the implant, total capsulectomy, and removal of any mass.
- New staging system, adapted from the American Joint Committee on Cancer TNM, is more prognostic than the Ann Arbor Staging System.
- Radiotherapy should be considered when complete excision fails.
- ≥Stage II, use anthracycline-based chemotherapy, with an overall response rate of 86%.