Guidelines for breast implant-associated anaplastic large-cell lymphoma

  • Jones JL & al.
  • Histopathology
  • 5 Jun 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • Systematic literature review.
  • Funding: None disclosed.

Key highlights

  • 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.
  • Pathology:
    • 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.
  • Management: 
    • Radiotherapy should be considered when complete excision fails.
    • ≥Stage II, use anthracycline-based chemotherapy, with an overall response rate of 86%.

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