What is BIA-ALCL?

BIA-ALCL is an immune cell-derived neoplasm that develops in the fibrous capsule surrounding the breast implant. Symptoms may include swelling, pain, breast asymmetry, lumps in the breast or axillary area, and skin lesions. It most commonly occurs 8-10 years after implantation, especially with textured implants.

When to perform an LP for BIA-ALCL?

Puncture for BIA-ALCL (breast implant-associated anaplastic large cell lymphoma) is recommended in situations where this rare cancer is suspected.

• Swelling and asymmetry of the breast - the hallmark symptom of BIA-ALCL is fluid (seroma) accumulating around the implant.
• Pain, redness and skin changes - may suggest an inflammatory process or the presence of a tumor.
• Palpable lumps or induration - the presence of a lump or induration in the breast or axillary area should prompt a diagnostic.
• Presence of fluid (seroma) around the implant - confirmed by ultrasound or MRI.
• Suspicion based on cytology and imaging findings - when previous imaging or cytology studies suggest changes in the capsule around the implant.
• Monitoring patients with textured breast implants.

How is the LP performed for BIA-ALCL?

The first step in the diagnosis of BIA-ALCL is to perform imaging studies like ultrasonography (USG) or magnetic resonance imaging (MRI). The tests allow assessment of the presence of fluid (seroma) or a mass within the capsule around the breast implant, which may indicate the presence of BIA-ALCL. Ultrasound is most commonly used because it allows quick and precise imaging of changes around the implant, as well as assessing the structure of the capsule and the presence of abnormal fluid. If the presence of seroma is suspected, the doctor may choose to perform the next diagnostic step - LP.

Puncture and aspiration

Fine needle puncture (FNA) is used to take a sample of fluid from around the implant capsule. The procedure is performed under local anesthesia to reduce patient discomfort. The procedure involves inserting a thin needle into the area suspected of having fluid, and then taking a sample, which is then analyzed.

It is recommended that the collected fluid sample has a volume of at least 50 ml. A larger volume of fluid increases the accuracy of the diagnosis, making it possible to obtain precise analysis results. In some cases, it may be necessary to repeat the procedure to obtain more material for the test.

The collected fluid is subjected to detailed analysis in the laboratory. Cytological and immunohistochemical examination of the sample is performed to detect the presence of CD30+ cells. CD30 is a protein that is characteristic of BIA-ALCL cells, which allows the diagnosis to be made. Through testing, it is possible to confirm whether a lesion within the implant capsule is indeed associated with this rare cancer.

Further diagnostics

If the presence of cancer cells is confirmed, PET/CT scans are performed. These advanced imaging techniques allow assessment of the spread of the disease and identification of possible metastases. PET/CT tomography is particularly useful in assessing the stage of BIA-ALCL and allows planning further treatment, which may include removal of the implant and fibrous capsule, and in more advanced cases, treatment with chemotherapy.

Contraindications to performing an LP for ALCL

The procedure is not recommended during pregnancy and breastfeeding. This is related to the need for caution in the use of anesthetics and to reduce the risk of any intervention that could affect the health of the mother or child.

In patients with blood clotting disorders, a doctor should be consulted for a risk assessment before performing an LP. Coagulation disorders increase the risk of bleeding, so patients with such problems must undergo a thorough medical evaluation before the procedure.

Also, the presence of infection at the site of the planned puncture is a relative contraindication to LP. In such cases, it may be necessary to postpone the procedure until the lesions have healed to avoid the risk of extending the inflammatory process.