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Expert panel agrees BIA-ALCL is less aggressive biologically, has good prognosis

After a review of the published literature, a multidisciplinary panel of 12 experts published their findings and assessment of a number of incompletely addressed issues pertaining to breast implant-associated anaplastic large-cell lymphoma.

The panel comprised three medical oncologists, four hematopathologists, two plastic surgeons, one surgical oncologist and two radiation oncologists from leading U.S. universities. All panelists were provided a draft of the literature review tables, along with a document providing background on breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), and were asked to rate a series of 65 statements on a scale of one to nine to indicate their levels of agreement. After a review of the initial ratings, the statements were revised and a second round of review was conducted. A total of 61 rating results were reported as a result.

Among the key items discussed was the proper nomenclature to describe the disease. The members of the panel agreed the best terminology to describe the occurrence of anaplastic large-cell lymphoma in the breast implant was breast implant-associated anaplastic large cell lymphoma. Additionally, the panelists were in agreement that late seromas, or those that occurred more than 1 year after breast implantation, should undergo evaluation with ultrasound. If seromas are found to be present, the panelists agreed fluid should be aspirated and sent to an experienced hematopathologist for culture, flow cytometry and cell block.

The panelists were in agreement that affected implants should be removed surgically as completely as possible, and that this process should be sufficient for complete eradication of capsule-confined BIA-ALCL. The panel also agreed that patients with BIA-ALCL should receive clinical follow-up at least every 6 months for at least 5 years with breast ultrasound for at least 2 years, and that those who undergo reimplantation should have surveillance continue beyond 5 years.

Overall, the panelists were in agreement with the concept that BIA-ALCL is, generally, a less biologically aggressive disease for which there is a good prognosis, provided the disease does not extend beyond the capsule or present as a mass. Additionally, the panelists were in firm disagreement that all patients with BIA-ALCL should be treated with chemotherapy or radiation therapy. - by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.