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Breast Implant-associated Anaplastic Large Cell Lymphoma: Updated Results from a Structured Expert Consultation Process.

Kim B, Predmore ZS, Mattke S, van Busum K, Gidengil CA - Plast Reconstr Surg Glob Open (2015)

Bottom Line: A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL.Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.

View Article: PubMed Central - PubMed

Affiliation: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.

ABSTRACT

Background: Despite increased cases published on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), important clinical issues remain unanswered. We conducted a second structured expert consultation process to rate statements related to the diagnosis, management, and surveillance of this disease, based on their interpretation of published evidence.

Methods: A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.

Results: Panelists agreed that (1) this disease should be called "BIA-ALCL"; (2) late seromas occurring >1 year after breast implantation should be evaluated via ultrasound, and if a seroma is present, the fluid should be aspirated and sent for culture, cytology, flow cytometry, and cell block to an experienced hematopathologist; (3) surgical removal of the affected implant and capsule (as completely as possible) should occur, which is sufficient to eradicate capsule-confined BIA-ALCL; (4) surveillance should consist of clinical follow-up at least every 6 months for at least 5 years and breast ultrasound yearly for at least 2 years; and (5) BIA-ALCL is generally a biologically indolent disease with a good prognosis, unless it extends beyond the capsule and/or presents as a mass. They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL.

Conclusions: Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.

No MeSH data available.


Related in: MedlinePlus

Algorithm for workup and surgical management of a late seroma following breast implantation. BIA-ALCL indicates breast implant–associated anaplastic large cell lymphoma; PET-CT, positron emission tomography-computed tomography.
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Figure 2: Algorithm for workup and surgical management of a late seroma following breast implantation. BIA-ALCL indicates breast implant–associated anaplastic large cell lymphoma; PET-CT, positron emission tomography-computed tomography.

Mentions: With summary tables from our updated systematic review and after the panel meeting, the current panelists judged only 11.5% of the final statements with a median rating in the uncertain range (35.4% in our previous panel).3 Although prior publications have termed this condition “breast implant-related anaplastic large cell lymphoma,”6 “implant-related primary anaplastic large cell lymphoma of the breast,”8 “lymphoma of the breast capsule,”11 and “effusion-associated anaplastic large cell lymphoma of the breast”28 and the panelists discussed using the term “lymphoproliferative disorder” instead of “lymphoma,” they ultimately consistently agreed that the nomenclature of this disease should be “breast implant–associated anaplastic large cell lymphoma,” which will hopefully be considered by the World Health Organization’s advisory committee responsible for the classification of lymphomas. There was firm disagreement with potential patient, surgical, and implant risk factors for increasing the risk of developing BIA-ALCL, although there was firm agreement regarding the workup and surgical management of patients suspected of having BIA-ALCL, which is graphically illustrated in algorithm form (Fig. 2).


Breast Implant-associated Anaplastic Large Cell Lymphoma: Updated Results from a Structured Expert Consultation Process.

Kim B, Predmore ZS, Mattke S, van Busum K, Gidengil CA - Plast Reconstr Surg Glob Open (2015)

Algorithm for workup and surgical management of a late seroma following breast implantation. BIA-ALCL indicates breast implant–associated anaplastic large cell lymphoma; PET-CT, positron emission tomography-computed tomography.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4323400&req=5

Figure 2: Algorithm for workup and surgical management of a late seroma following breast implantation. BIA-ALCL indicates breast implant–associated anaplastic large cell lymphoma; PET-CT, positron emission tomography-computed tomography.
Mentions: With summary tables from our updated systematic review and after the panel meeting, the current panelists judged only 11.5% of the final statements with a median rating in the uncertain range (35.4% in our previous panel).3 Although prior publications have termed this condition “breast implant-related anaplastic large cell lymphoma,”6 “implant-related primary anaplastic large cell lymphoma of the breast,”8 “lymphoma of the breast capsule,”11 and “effusion-associated anaplastic large cell lymphoma of the breast”28 and the panelists discussed using the term “lymphoproliferative disorder” instead of “lymphoma,” they ultimately consistently agreed that the nomenclature of this disease should be “breast implant–associated anaplastic large cell lymphoma,” which will hopefully be considered by the World Health Organization’s advisory committee responsible for the classification of lymphomas. There was firm disagreement with potential patient, surgical, and implant risk factors for increasing the risk of developing BIA-ALCL, although there was firm agreement regarding the workup and surgical management of patients suspected of having BIA-ALCL, which is graphically illustrated in algorithm form (Fig. 2).

Bottom Line: A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL.Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.

View Article: PubMed Central - PubMed

Affiliation: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.

ABSTRACT

Background: Despite increased cases published on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), important clinical issues remain unanswered. We conducted a second structured expert consultation process to rate statements related to the diagnosis, management, and surveillance of this disease, based on their interpretation of published evidence.

Methods: A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.

Results: Panelists agreed that (1) this disease should be called "BIA-ALCL"; (2) late seromas occurring >1 year after breast implantation should be evaluated via ultrasound, and if a seroma is present, the fluid should be aspirated and sent for culture, cytology, flow cytometry, and cell block to an experienced hematopathologist; (3) surgical removal of the affected implant and capsule (as completely as possible) should occur, which is sufficient to eradicate capsule-confined BIA-ALCL; (4) surveillance should consist of clinical follow-up at least every 6 months for at least 5 years and breast ultrasound yearly for at least 2 years; and (5) BIA-ALCL is generally a biologically indolent disease with a good prognosis, unless it extends beyond the capsule and/or presents as a mass. They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL.

Conclusions: Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.

No MeSH data available.


Related in: MedlinePlus