Clinical recommendations for diagnosis and treatment according to current updated knowledge on BIA-ALCL
Benedetto Longo,
Arianna Di Napoli,
Giuseppe Curigliano,
Paolo Veronesi,
Stefano Pileri,
Maurizio Martelli,
Roy De Vita,
Nicola Felici,
Pierfrancesco Cirillo,
Claudio Bernardi,
Gennaro D'orsi,
Martina Giacalone,
Gabriele Storti,
Valerio Cervelli
Affiliations
Benedetto Longo
Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy; Corresponding author.Via Montpellier, 1, 00133, Rome, Italy.
Arianna Di Napoli
Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Clinical and Molecular Medicine, Sapienza University, Sant’Andrea Hospital, Rome, Italy
Giuseppe Curigliano
Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy
Paolo Veronesi
Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Oncology and Haemato-Oncology, University of Milano, Milan, Italy; Division of Breast Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
Stefano Pileri
Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Haematopathology Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
Maurizio Martelli
Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Department of Translational and Precision Medicine “Sapienza” University, Rome, Italy
Roy De Vita
Group of Experts on BIA-ALCL at the Italian Ministry of Health, Italy; Plastic Surgery Department, National Institute for Cancer, Rome, Italy
Nicola Felici
President of the Italian Society of Microsurgery (SIM), Division of Limbs Reconstructive Surgery, San Camillo-Forlanini Hospital, Rome, Italy
Pierfrancesco Cirillo
President of the Italian Association of Aesthetic Plastic Surgery (AICPE). Private Practice, Via Sergio Forti, 39, 00144, Rome, Italy
Claudio Bernardi
President Elect of the Italian Association of Aesthetic Plastic Surgery (AICPE). Private Practice, Via Anneo Lucano, 5, 00136, Rome, Italy
Gennaro D'orsi
Department of Surgical Sciences, School of Medicine and Surgery, PhD Program in Medical-Surgical Applied Sciences, Tor Vergata University of Rome, Italy
Martina Giacalone
Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
Gabriele Storti
Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
Valerio Cervelli
Chair of Plastic Surgery, Department of Surgical Sciences, School of Medicine and Surgery, Tor Vergata University of Rome, Italy
Shared strategies and correct information are essential to guide physicians in the management of such an uncommon disease as Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). A systematic review of the literature was performed to collect the most relevant evidence on BIA-ALCL reported cases. A panel of multidisciplinary experts discussed the scientific evidence on BIA-ALCL, and updated consensus recommendations were developed through the Delphi process. The lastest reported Italian incidence of BIA-ALCL is 3.5 per 100.000 implanted patients (95% CI, 1.36 to 5.78), and the disease counts over 1216 cases worldwide as of June 2022. The most common presentation symptom is a late onset seroma followed by a palpable breast mass. In the event of a suspicious case, ultrasound-guided fine-needle aspiration should be the first step in evaluation, followed by cytologic and immunohistochemical examination. In patients with confirmed diagnosis of BIA-ALCL confined to the capsule, the en-bloc capsulectomy should be performed, followed by immediate autologous reconstruction, while delayed reconstruction applies for disseminate disease or radically unresectable tumor. Nevertheless, a multidisciplinary team approach is essential for the correct management of this pathology.
