Diagnosis of Breast Implant Associated Large Cell Lymphoma

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Periprosthetic fluid collections:
    • Occurring more than 1 year after implantation:
      • Should be evaluated to rule out breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)
  • Diagnosis of BIA-ALCL:
    • Is made by aspiration of the periprosthetic fluid:
      • Usually performed by fine needle aspiration:
        • Under ultrasound guidance
      • A sample of 50 ml or greater is sufficient to establish a diagnosis by CD30 immunohistochemistry:
        • CD30 is a cell surface protein expressed by roughly 5% of normal circulating T-cells:
          • However, BIA-ALCL demonstrates confluent staining of CD30
  • Open biopsy:
    • Is more invasive, and the capsule may be negative even in the presence of disease
  • Therefore, effusion FNA is preferred for diagnosis
  • Plastic surgery evaluation:
    • Is not appropriate or necessary
  • Mammogram evaluation is non-specific for a disease process and is not indicated with an obvious fluid collection
  • References
    • Clemens MW, Horwitz S. NCCN Consensus Guidelines for the diagnosis and management of breast implant-associated anaplastic large cell lymphoma. Aesth Surg J. 2017;37(3):285-289.
    • Brody GS, Deapen D, Taylor CR. Anaplastic large cell lymphoma occurring in women with breast implants: analysis of 173 cases. Plast Reconstr Surg. 2015;135(3):695-705.
    • Horwitz SM, Ansell SM, Ai WZ, Barnes J, Barta SK, Choi M, et al. NCCN guidelines insights: t-cell lymphomas, version 2.2018. J Natl Compr Canc Netw. 2018;16(2):123-135.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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