Fabio Santanelli di Pompeo1, Mark W Clemens2, Michael Atlan3, Giovanni Botti, Peter G Cordeiro4, Daphne De Jong5, Arianna Di Napoli6, Dennis Hammond, Cara L Haymaker7, Steven M Horwitz8, Kelly Hunt9, Peter Lennox10, Patrick Mallucci, Roberto N Miranda11, Alexandre M Munhoz12, Eric Swanson, Suzanne D Turner13, Guido Firmani14, Michail Sorotos1. 1. Faculty of Medicine and Psychology, Sapienza University of Rome, Department NESMOS, Sant'Andrea Hospital, Rome, Italy. 2. Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA and is a Breast Surgery section editor for Aesthetic Surgery Journal. 3. Aesthetic Plastic Reconstructive Unit/CHU TENON PARIS-APHP, Université Pierre et Marie Curie, Paris, France. 4. Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 5. Amsterdam UMC-Vrije Universiteit Amsterdam, Department of Pathology and Cancer Center Amsterdam, Amsterdam, the Netherlands. 6. Pathology Unit, Department of Clinical and Molecular Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy. 7. Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 8. Lymphoma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 9. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 10. Department of Surgery, Division of Plastic and Reconstructive Surgery, University of British Columbia, Vancouver, BC, Canada and is a clinical editor for Aesthetic Surgery Journal. 11. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 12. Plastic Surgery Department, Hospital Moriah, Hospital Sírio-Libanês, Higienópolis, São Paulo, Brazil. 13. Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. 14. Faculty of Medicine and Psychology, Sapienza University of Rome, Department of Plastic Surgery, Sant'Andrea Hospital, Rome, Italy.
Abstract
BACKGROUND: Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES: The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS: A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS: The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS: BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology.
BACKGROUND: Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3rd World Consensus Conference on BIA-ALCL. OBJECTIVES: The authors sought to provide practice recommendations from a consensus of experts, supplemented with a literature review regarding epidemiology, etiology, pathogenesis, diagnosis, treatment, socio-psychological aspects, and international authority guidance. METHODS: A literature search of all manuscripts between 1997 and August 2021 for the above areas of BIA-ALCL was conducted with the PubMed database. Manuscripts in different languages, on non-human subjects, and/or discussing conditions separate from BIA-ALCL were excluded. The study was conducted employing the Delphi process, gathering 18 experts panelists and utilizing email-based questionnaires to record the level of agreement with each statement by applying a 5-point Likert Scale. Median response, interquartile range, and comments were employed to accept, reject, or revise each statement. RESULTS: The literature search initially yielded 764 manuscripts, of which 405 were discarded. From the remaining 359, only 218 were included in the review and utilized to prepare 36 statements subdivided into 5 sections. After 1 round, panelists agreed on all criteria. CONCLUSIONS: BIA-ALCL is uncommon and still largely underreported. Mandatory implant registries and actions by regulatory authorities are needed to better understand disease epidemiology and address initial lymphomagenesis and progression. Deviation from current diagnosis and treatment protocols can lead to disease recurrence, and research on breast implant risk factors provide insight to etiology.