ASCO Issues Guidelines on Implant-Associated Lymphoma

The American Society for Clinical Oncology (ASCO) recently issued practice guidelines for pathologic diagnosis of breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) to help healthcare practitioners better this rare disease.

The ASCO guidelines are coming after much debate by the Food and Drug Administration (FDA), which eventually took action in October 2019 by recommending new labeling guidelines for the texturized breast implants that may be associated with BIA-ALCL.

“The objective of this article is to provide additional guidance to healthcare providers … regarding the recognition and diagnosis of BIA-ALCL using a standardized pathologic protocol for clinical evaluation of patients,” the guidelines state. “This protocol includes evaluation of the periprosthetic fluid when present and processing of capsulectomy specimens. With increased education for both the public and healthcare providers, the hope is to identify and diagnose BIA-ALCL early when intervention can be curative.”

Symptoms of BIA-ALCL can include breast swelling, asymmetry/a “full” sensation, and sometimes pain, and the average woman with BIA-ALCL experiences these symptoms about 8 to 10 years after getting the implants.

Most patients have effusion (seroma), so an important first step in diagnosing BIA-ALCL is ultrasound-guided aspiration (fine-needle aspiration [FNA] of the effusion) of at least 10 to 50 mL to be undergo cytologic evaluation.

Then, the following steps should be taken:

• Cytocentrifugation and filtration of fresh, unfixed effusion fluid to produce air-dries smears stained with Wright-Giemsa or other Romanowsky-type stains
• Prepare the cell block to allow for hematoxylin and eosin staining and immunohistochemical analysis of formalin-fixed paraffin-embedded histologic sections
• Fixation and mapping of the capsulectomy specimen to select multiple representative sections
• Assess lymph node involvement via excisional biopsy

“Early diagnosis of BIA-ALCL is important as the disease can progress and deaths have been reported,” the guidelines state.

Reference

Jaffe ES, Ashar BS, Clemens MW, et. al. Best Practices Guidelines for the Pathologic Diagnosis of Breast-Implant Associated Anaplastic Large-Cell Lymphoma. Journal of Clinical Oncology. February 2020. Accessed March 3, 2020.