St James's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Royal Marsden NHS Foundation Trust, London, UK.
J Plast Reconstr Aesthet Surg. 2021 Jan;74(1):13-29. doi: 10.1016/j.bjps.2020.10.064. Epub 2020 Nov 12.
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.
乳房植入物相关间变性大细胞淋巴瘤(BIA-ALCL)是一种罕见的与乳房植入物相关的 T 细胞非霍奇金淋巴瘤(NHL)。提高对任何乳房植入物和新乳房症状患者中 BIA-ALCL 可能性的认识,对于早期诊断至关重要。肿瘤始于植入物周围胶囊的内侧,导致积液,或不太常见的是在胶囊内形成组织肿块,可能局部扩散或扩散到身体的更远部位。诊断通常通过对植入物周围液的细胞学、免疫组织化学和免疫表型评估来进行:多形性淋巴细胞特征性地为间变性淋巴瘤激酶(ALK)阴性,CD30 阳性强烈。BIA-ALCL 在大多数患者中为惰性,但可能迅速进展。通常通过切除带有完整周围胶囊的植入物(全切除胶囊)来进行治疗。晚期诊断可能需要更激进的手术和系统治疗,尽管这些治疗通常是成功的,但仍有报道称预后不良和死亡。通过采用这些指南中建议的结构化方法,可以早期诊断和成功治疗,从而最大限度地减少系统治疗的需求,降低发病率和不良预后的风险。这些指南为疑似或确诊 BIA-ALCL 患者的评估和治疗提供了循证和系统的框架,适用于所有参与乳房植入物患者护理的临床医生。