Tevis Sarah E, Hunt Kelly K, Clemens Mark W
Assistant Professor of Surgery at Department of Surgery, University of Colorado, Aurora, CO.
The Chair and a Professor at Department of Breast Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
Aesthet Surg J Open Forum. 2019 Feb 27;1(1):ojz005. doi: 10.1093/asjof/ojz005. eCollection 2019 Mar.
Guidelines published by the National Comprehensive Cancer Network state that standard of care treatment for the majority of patients with breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is surgical resection. This cancer is generally indolent, and if confined to the capsule, curative treatment is usually surgery alone. An en bloc resection involves a total capsulectomy, explantation, complete excision of associated masses, and excision of any involved lymph node(s). Patients with surgical control of disease have favorable long-term overall and event-free survival. Oncologic principles should be applied when resecting BIA-ALCL, and a complete oncologic resection is essential to cure patients of the disease. Incomplete resections, partial capsulectomies, and positive margins are all associated with high rates of disease recurrence and have potential for progression of the disease. Routine sentinel lymph node biopsy is unnecessary and full axillary lymph node dissection is rarely indicated except in cases of proven involvement of multiple nodes. Lymphoma oncology consultation and disease staging by imaging is performed prior to surgery. Importantly, en bloc resection is indicated only for an established diagnosis of BIA-ALCL, and is not recommended for merely suspicious or prophylactic surgeries. The purpose of this article was to demonstrate a stepwise approach to surgical ablation of BIA-ALCL with an emphasis on oncologic considerations critical to disease prognosis.
美国国立综合癌症网络发布的指南指出，对于大多数乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）患者，标准的治疗方法是手术切除。这种癌症通常发展缓慢，如果局限于包膜内，通常仅通过手术就能治愈。整块切除包括完整的包膜切除术、植入物取出术、相关肿块的完全切除以及任何受累淋巴结的切除。疾病得到手术控制的患者具有良好的长期总体生存率和无事件生存率。切除BIA-ALCL时应遵循肿瘤学原则，完整的肿瘤切除对于治愈患者至关重要。切除不完全、部分包膜切除以及切缘阳性均与疾病复发率高相关，且有疾病进展的可能。常规前哨淋巴结活检没有必要，除非证实有多个淋巴结受累，很少需要进行全腋窝淋巴结清扫。手术前需进行淋巴瘤肿瘤学会诊并通过影像学进行疾病分期。重要的是，整块切除仅适用于已确诊的BIA-ALCL，不建议仅用于可疑或预防性手术。本文的目的是展示一种逐步进行BIA-ALCL手术切除的方法，重点关注对疾病预后至关重要的肿瘤学考量。
