Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
Office of Surgical and Infection Control Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD.
J Clin Oncol. 2020 Apr 1;38(10):1102-1111. doi: 10.1200/JCO.19.02778. Epub 2020 Feb 11.
To provide guidelines for the accurate pathologic diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), the preoperative evaluation of the patient with suspected BIA-ALCL, and the pathologic evaluation of the capsulectomy specimen.
To better inform patients and healthcare providers about BIA-ALCL, we convened to review diagnostic procedures used in the evaluation of patients with suspected BIA-ALCL. We focused on the processing of the seroma fluid/effusion surrounding the implant, the handling of capsulectomy specimens following removal of implant(s), and the preoperative evaluation of the patient with suspected BIA-ALCL. Recommendations were based on the published literature and our experience to optimize procedures to obtain an accurate diagnosis and assess for tumor invasion and the extent of the disease.
Early diagnosis of BIA-ALCL is important as the disease can progress and deaths have been reported. Because the most common presentation of BIA-ALCL is swelling of the breast with fluid collection, an accurate diagnosis requires cytologic evaluation of the effusion fluid surrounding the affected implant. The first priority is cytocentrifugation and filtration of fresh, unfixed effusion fluid to produce air-dried smears that are stained with Wright-Giemsa or other Romanowsky-type stains. Preparation of a cell block is desirable to allow for hematoxylin and eosin staining and immunohistochemical analysis of formalin-fixed, paraffin-embedded histologic sections. Cell block sections can be used for polymerase chain reaction-based investigation of T-cell receptor gene rearrangement to detect clonality. Fixation and mapping of the capsulectomy specimen to select multiple representative sections are advised to assess for microscopic tumor involvement and capsular invasion. It is appropriate to assess lymph node involvement by excisional biopsy material rather than fine needle aspiration, due to propensity for focal involvement.
为准确诊断乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）提供指导，对疑似 BIA-ALCL 患者进行术前评估，并对包膜切除术标本进行病理评估。
为了更好地向患者和医疗保健提供者告知 BIA-ALCL，我们召集了一次会议，审查了用于评估疑似 BIA-ALCL 患者的诊断程序。我们重点关注了围绕植入物的浆膜液/渗出液的处理、移除植入物后包膜切除术标本的处理，以及疑似 BIA-ALCL 患者的术前评估。建议基于已发表的文献和我们的经验，旨在优化程序以获得准确的诊断，并评估肿瘤侵袭和疾病的程度。
早期诊断 BIA-ALCL 很重要，因为该疾病会进展，并且已有死亡报告。由于 BIA-ALCL 最常见的表现是乳房肿胀伴积液，因此准确的诊断需要对受影响植入物周围的积液进行细胞学评估。首要任务是对新鲜、未经固定的渗出液进行离心和过滤，以产生空气干燥的涂片，并用 Wright-Giemsa 或其他 Romanowsky 型染色剂染色。制备细胞块以允许对福尔马林固定、石蜡包埋的组织学切片进行苏木精和伊红染色和免疫组织化学分析是可取的。细胞块切片可用于基于聚合酶链反应的 T 细胞受体基因重排检测以检测克隆性。建议固定和映射包膜切除术标本以选择多个代表性切片，以评估微观肿瘤浸润和包膜侵犯。由于倾向于局灶性受累，因此评估淋巴结受累应通过切除活检材料而不是细针抽吸来进行。
