Anaplastic Large Cell Lymphoma Associated with Breast Implants

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 1.00
Procedures: 1.00
Pathology: 1.00

Computed Tomography: 0.25
Procedures: 0.25
Neck and Chest: 0.25

Mammography: 1.25
Procedures: 1.25
Anatomy, Physiology, and Pathology: 1.25

Magnetic Resonance Imaging: 0.50
Procedures: 0.50
Body: 0.50

Nuclear Medicine Technology: 0.50
Procedures: 0.50
Endocrine and Oncology Procedures: 0.50

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Thoracic Section: 2.00

Sonography: 1.00
Procedures: 1.00
Superficial Structures and Other Sonographic Procedures: 1.00

Radiation Therapy: 2.25
Procedures: 2.25
Treatment Sites and Tumors: 1.00
Treatments: 1.25

Outline

1. Introduction
2. Definition
3. History
4. Epidemiology
5. Etiology and Pathophysiology
6. Clinical Features
7. Differential Diagnosis
8. Histologic Features
9. Radiologic Features
   1. Ultrasonography
   2. Mammography
   3. Computed Tomography
   4. MR Imaging
   5. Positron Emission Tomography
10. Diagnosis
    1. Initial Assessment
    2. Perioperative Workup
11. Staging
12. Response Assessment
13. Treatment
    1. Surgical Therapy
    2. Systemic Therapy
    3. Breast Reconstruction
14. Prognosis
15. Surveillance
16. Future Directions
    1. Whole-Body DWI
    2. Novel PET Radiotracers
    3. Evaluation of Minimal Residual Disease and Circulating DNA
17. Conclusion

Objectives

Upon completion of this course, students will:

1. know when systemic therapy might be used for BIA-ALCL patients
2. be familiar with the various abbreviations used in BIA-ALCL investigations
3. know what is critical to optimal management of lymphoma patients
4. know the lymphoid neoplasm classification group that BIA-ALCL falls into, according to the World Health Organization
5. identify the clinicopathologic subtypes of BIA-ALCL
6. know the type of breast implants for which evidence has indicated BIA-ALCL is a complication
7. understand why the absolute risk of BIA-ALCL might be higher than the predicted values from recent Dutch and U.S. studies
8. be familiar with the various entities to whom new BIA-ALCL cases should be reported
9. be familiar with the various hypotheses for patients developing BIA-ALCL
10. recognize the factors investigated to determine whether they have an affect on BIA-ALCL risk
11. be familiar with the skin lesions with which BIA-ALCL patients most commonly present
12. be familiar with BIA-ALCL incidence rates and the factors which affect them
13. be familiar with the late seroma differential diagnosis and its common causes in breast implant patients
14. understand how to differentiate late seromas from BIA-ALCL
15. be familiar with the differential diagnoses for mass-forming BIA-ALCL
16. be familiar with the histologic features of BIA-ALCL cells at capsulectomy in patients presenting with effusion around the implant
17. know the radiologic imaging techniques that are routinely used in breast radiology and in oncology for implant assessment
18. be familiar with the strengths and weaknesses of radiologic techniques in BIA-ALCL
19. know the radiologic imaging modality that is the appropriate initial test to evaluate swelling or pain in relation to a breast implant
20. recognize how BIA-ALCL mass disease usually manifests at ultrasound
21. know conditions that mammography may detect in some BIA-ALCL cases
22. know which BIA-ALCL subtypes can be defined at CT
23. be familiar with the principle value of CT for BIA-ALCL evaluation
24. know the second imaging test of choice for BIA-ALCL diagnosis
25. be familiar with the general clinical advantages of PET imaging
26. be familiar with Lugano Classification and the Deauville criteria
27. recognize the clinically important nuances with PET/CT use for evaluating BIA-ALCL
28. know what the initial breast ultrasound screening for BIA-ALCL should assess
29. be familiar with the original imaging paradigm for the management of both peri-implant effusion-only and mass-forming subtypes of BIA-ALCL
30. know what teams should be involved in a multidisciplinary meeting for BIA-ALCL cases
31. be familiar with the proposed TNM staging system from the NCCN consensus guidelines for BIA-ALCL
32. describe complete surgical therapy in the peri-implant effusion subtype of BIA-ALCL
33. be familiar with the various drugs used in BIA-ALCL systemic therapy
34. recognize why patients with more advanced BIA-ALCL should delay reconstruction
35. be familiar with the overall survival rates and event-free survival rates for the subtypes of BIA-ALCL
36. understand why this paper does not advocate for routine imaging surveillance in BIA-ALCL cases
37. be familiar with diffusion-weighted MR imaging and its potential uses
38. understand the advantages of whole-body DWI MR for BIA-ALCL
39. be familiar with CD30 which may provide a sensitive and specific test for BIA-ALCL staging and response assessment
40. be familiar with the goal of elimination of minimal disease to improve cancer outcomes