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Turton P, El-Sharkawi D, Lyburn I, Sharma B, Mahalingam P, Turner SD, MacNeill F, Johnson L, Hamilton S, Burton C, Mercer N. UK Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) on behalf of the Medicines and Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG). J Plast Reconstr Aesthet Surg 2020; 74:13-29. [PMID: 33483089 DOI: 10.1016/j.bjps.2020.10.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/20/2020] [Indexed: 12/30/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T cell Non-Hodgkin Lymphoma (NHL) associated with breast implants. Raising awareness of the possibility of BIA-ALCL in anyone with breast implants and new breast symptoms is crucial to early diagnosis. The tumour begins on the inner aspect of the peri-implant capsule causing an effusion, or less commonly a tissue mass to form within the capsule, which may spread locally or to more distant sites in the body. Diagnosis is usually made by cytological, immunohistochemical and immunophenotypic evaluation of the peri-implant fluid: pleomorphic lymphocytes are characteristically anaplastic lymphoma kinase (ALK) negative and strongly positive for CD30. BIA-ALCL is indolent in most patients but can progress rapidly. Surgical removal of the implant with the intact surrounding capsule (total en-bloc capsulectomy) is usually curative. Late diagnosis may require more radical surgery and systemic therapies and although these are usually successful, poor outcomes and deaths have been reported. By adopting a structured approach, as suggested in these guidelines, early diagnosis and successful treatment will minimize the need for systemic treatments, reduce morbidity and the risk of poor outcomes. These guidelines provide an evidence-based and systematic framework for the assessment and treatment of patients with suspected or proven BIA-ALCL and are aimed at all clinicians involved in the care of people with breast implants.
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Affiliation(s)
- Philip Turton
- St James's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | | | - Iain Lyburn
- Cobalt Medical Charity, Cheltenham, UK; Gloucestershire Hospitals NHS Foundation Trust, UK
| | | | | | - Suzanne D Turner
- Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge CB20QQ, UK; CEITEC, Masaryk University, Brno, Czech Republic
| | | | | | | | - Cathy Burton
- St James's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nigel Mercer
- Bristol Plastic Surgery, 58 Queen Square, Bristol BS1 4LF
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Jaffe ES, Feldman AL, Gaulard P, Miranda RN, Sohani AR. Reply to M. Romero et al. J Clin Oncol 2020; 38:2819-2820. [PMID: 32552469 DOI: 10.1200/jco.20.00931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Elaine S Jaffe
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew L Feldman
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Philippe Gaulard
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Roberto N Miranda
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Aliyah R Sohani
- Elaine S. Jaffe, MD, Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Andrew L. Feldman, MD, Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN; Philippe Gaulard, MD, PhD, Departement de Pathologie, Hôpital Henri Mondor, Inserm U955, Université Paris-Est, Créteil, France; Roberto N. Miranda, MD, Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX; and Aliyah R. Sohani, MD, Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Romero M, Melo A, Bedoya N, de la Hoz J, Mejía-Arango M, Galvis K, Hernandez L, Cuellar G, Martin L, Quijano S, Saavedra C. Should Flow Cytometry Be Considered a First Line of Study in the Diagnosis of Breast Implant-Associated Anaplastic Large-Cell Lymphoma? J Clin Oncol 2020; 38:2816-2819. [PMID: 32552470 DOI: 10.1200/jco.20.00712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Martha Romero
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Andrés Melo
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nelson Bedoya
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - José de la Hoz
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Marcela Mejía-Arango
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Karen Galvis
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Luz Hernandez
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Gina Cuellar
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Liliana Martin
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sandra Quijano
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carlos Saavedra
- Martha Romero, MD, PhD; Andrés Melo, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; Nelson Bedoya, MD, Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; José de la Hoz, MD, Department of Clinical Studies, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia; and Marcela Mejía-Arango, MD; Karen Galvis, MD; Luz Hernandez, BS; Gina Cuellar, BS; Liliana Martin, BS; Sandra Quijano, PhD; Carlos Saavedra, MD, Department of Pathology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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