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.
