Management of suspected and confirmed BIA-ALCL

BIA-ALCL: breast implant-associated anaplastic large cell lymphoma; PROFILE: Patient Registry and Outcomes for Breast Implants and Anaplastic Large Cell Lymphoma (ALCL) Etiology and Epidemiology; PET-CT: positive emission tomography-computed tomography; ALK: anaplastic lymphoma kinase; MRI: magnetic resonance imaging.
* Physical symptoms/signs include effusion surrounding breast implant; breast mass adjacent to implant; and swelling, pain, and/or skin lesion/ulceration of the breast. They typically occur >1 year after implantation (average 10 years) but can occur earlier.
¶ If breast ultrasound is not conclusive, the next line of imaging is breast MRI or PET-CT.
Δ Aspiration of effusion should be sent for CD30 immunohistochemistry, cell block cytology to evaluate for large anaplastic cells, and flow cytometry to evaluate for clonal expansion of a T-cell population.
◊ BIA-ALCL is confirmed histologically with demonstration of a neoplasm that has large lymphoid cells with abundant cytoplasm and pleomorphic nuclei and is negative for ALK and positive for CD30.
§ Differentiate BIA-ALCL from other types of lymphoma, primary cutaneous ALCL, and systemic ALCL with breast involvement.
¥ For more information, visit the PROFILE website at www.thepsf.org/PROFILE/.
‡ Complete surgical excision includes removal of the implant including the surrounding capsule, removal of any disease mass with negative margins, and excision of involved lymph nodes.
† Based upon imaging findings (PET-CT) and pathologic findings at the time of surgical resection. Local therapy only: Stage IE (Lugano), Stage 1A to 2A (MD Anderson). Radiation or adjuvant chemotherapy: Stage IIE (Lugano), Stage 2B through 4 (MD Anderson).
** Obtain biopsies to confirm residual, disseminated, or recurrent disease suspected on imaging.
¶¶ Patients are observed with a clinical follow-up, history, and physical every six months for two years and then as clinically indicated. Physicians may include chest/abdominal/pelvic computed tomography (CT) scans with contrast or PET scan every 6 months for 2 years as clinically indicated.
ΔΔ Chemotherapy with either brentuximab vedotin or anthracycline-based regimen (ie, CHOP, cyclophosphamide, vincristine, doxorubicin, prednisone) as for de novo ALK-negative ALCL.