ALCL, the rare lymphoma associated with textured implants, is being researched more and more. I did a recent CME course on the subject, and I need to update some of the information from my prior blogs, as some of the numbers have changed.
FACTS from the CME article: (Though the publication is in 2019, the numbers are as of Feb 2018. This is evolving.)
- ALCL only has been reported in textured implants.
- It presents most commonly with a rapid onset of a spontaneous fluid collection (60-90%) OR a capsular mass (10-40%)
- Any seroma occurring more than one year after implant not readily explainable by infection or trauma should be considered suspicious for disease.
- It occurs on average 8-10 years after breast implantation with textured implants.
- In prospective studies, they estimate BIA ALCL happens in 9-13% of delayed seroma presentations.
- As of Feb 2018, the number of cases
- 518 unique cases
- 25 countries
- 194 cases in the US.
DIAGNOSIS:
- Ultrasound is most often used to diagnose a fluid collection
- Fine needle aspiration is done to collect fluid for analysis.
- They need 20-50cc of fluid. (100cc is ideal) to do analysis, looking for CD30 immunohistochemistry.
- There is no special collection tube needed. It should be analyzed ideally within 48 hours.
- This can be done in a clinic or by interventional radiology.
- If there is a mass, specimen should be sent for cell block cytology, again looking for CD30 immunohistochemistry.
- The clinical history and directions to evaluate for BIA ALCL should go to pathology.
IF POSITIVE:
Then you need to register the case with the registry, send to oncology for a multidisciplinary team evaluation, and a CT scan or PET scan to evaluate the extent of the disease. Treatment involves resection of the capsule, removal of the implant, and possible chemotherapy or other modalities depending on the extent of the disease. Please see the next blog re: treatment.
OF NOTE:
Allergan has funds available for some of the costs and testing. Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) coverage for both gel and saline patients If you have breast implants, you have an increased risk of developing BIA-ALCL. If you have textured implants, Allergan will cover up to $1000 of out-of-pocket fees toward diagnostic testing for BIA-ALCL.† In the event of a BIA-ALCL diagnosis, all Allergan implant patients are eligible for up to $7500 of out-of-pocket surgical financial assistance toward the removal of the breast implant(s) and the associated scar tissue (complete capsulectomy). Allergan will also provide replacement implant(s) at no charge. For coverage eligibility, surgeons are directed to contact Allergan and provide appropriate documentation. Coverage valid for cases diagnosed on or after January 1, 2018. The link to Allergan’s policy is HERE.
Also some major health insurance companies are covering the treatment in their plans.