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Anaplastic large cell lymphoma and breast implants: results from a structured expert consultation process
Benjamin Kim1, Carol Roth, V Leroy Young
1Santa Monica and Los Angeles, Calif.; Boston, Mass.; St. Louis, Mo.; and Ann Arbor, Mich. From RAND Health and Pardee RAND Graduate School, RAND Corporation; the Division of Hematology-Oncology, Department of Medicine, David Geffen School of Medicine at UCLA; Body Aesthetic Plastic Surgery and Skincare Center; and the Section of Plastic Surgery, Department of Surgery, University of Michigan Health System.
Background:
There are increasing concerns about a possible association between anaplastic large cell lymphoma (ALCL) and breast implants. The authors conducted a structured expert consultation process to evaluate the evidence for the association, its clinical significance, and a potential biological model based on their interpretation of the published evidence.
Methods:
A multidisciplinary panel of 10 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.
Results:
Panelists agreed that (1) there is a positive association between breast implants and ALCL development but likely underrecognition of the true number of cases; (2) a recurrent, clinically evident seroma occurring 6 months or more after breast implantation should be aspirated and sent for cytologic analysis; (3) anaplastic lymphoma kinase-negative ALCL that develops around breast implants is a clinically indolent disease with a favorable prognosis that is distinct from systemic anaplastic lymphoma kinase-negative ALCL; (4) management should consist of removal of the involved implant and capsule, which is likely to prevent recurrence, and evaluation for other sites of disease; and (5) adjuvant radiation or chemotherapy should not be offered to women with capsule-confined disease. Little agreement, however, was found regarding etiologic risk factors for implant-associated ALCL.
Conclusion:
The authors' assessment yielded consistent results on a number of key issues regarding ALCL in women with breast implants, but substantial further research is needed to improve our understanding of the epidemiology, clinical aspects, and biology of this disease.
Clinical Question/Level Of Evidence:
Risk, V.
