Should Flow Cytometry Be Considered a First Line of Study in the Diagnosis of Breast Implant–Associated Anaplastic Large-Cell Lymphoma?

Romero, Martha; Melo, Andrés; Bedoya, Nelson; Hoz, Jose De la; Mejía-Arango, Marcela; Galvis, Karen; Hernández, L. Hernández; Cuellar, Gina; Martin, Liliana; Quijano, Sandra; Saavedra, Carlos

doi:10.1200/jco.20.00712

Cited by 6 publications

(11 citation statements)

References 8 publications

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“…While some cases of BIA-ALCL reported in the literature were evaluated by flow cytometry, in most cases the immunophenotype was determined by immunohistochemical analysis (Quesada et al, 2019). Meanwhile, a recent study using flow cytometry found 11.11% (4/36) of lymphomas associated with breast prostheses and suggested that this technique may be useful to detect and rule out negative cases (Romero et al, 2020). where CD30 positive elements were extremely rare (<5%), while in the confirmed BIA-ALCL cases atypical CD30-positive cells represented more than 70% of the cellularity (Di Napoli et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Use of flow cytometry and cytology to differentiate breast implant‐associated anaplastic large cell lymphoma from reactive seromas in Brazilian patients

Azambuja

Gevert

Oliveira

et al. 2021

Cytometry Part B Clinical

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Introduction:The combination of cytology and multiparametric flow cytometry (MFC) may be useful in the diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and may be a practical way to differentiate lymphoma from benign and reactive seromas. Although the Brazilian breast implant market is the second largest in the world, with several manufacturers and the almost exclusive use of textured implants, the occurrence of BIA-ALCL in Brazil is underreported. Methods: One hundred seventeen sequential collections of suspicious periprosthetic fluid (PF) from 105 Brazilian patients registered between March/2018 and March/2021 were evaluated by routine cytomorphology and flow cytometry. The combination of CD30, HLA-DR, and CD25 was used together with T and B lymphocyte and monocyte evaluation. The PF samples were divided into positive, acute reactive (neutrophilic exudate), or chronic reactive (macrophage or lymphocyte rich), and unavailable samples. Results: Nine BIA-ALCL positive cases (7.7%) were identified, with typical morphology and increased FSC/SSC dispersion, bright expression of CD30, CD25 and HLA-DR, and absence or weakness of T-cell antigens (CD3, CD8, CD4, CD5, and CD7). Reactive samples were acute (n = 18, 15.4%) and chronic (n = 70, 59.8%). Twenty samples were excluded. The mean age of BIA-ALCL patients was 50 years (31-57 years) and 35 years in reactive patients (20-69 years). Conclusion: Use of MFC with a comprehensive antibody panel consisting of CD30 in conjunction with CD25 and HLA-DR can discriminate anaplastic cells of BIA-ALCL from lymphoid or neutrophilic reactive cells and should be considered in the initial evaluation of seroma.

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Section: Discussionmentioning

confidence: 99%

Use of flow cytometry and cytology to differentiate breast implant‐associated anaplastic large cell lymphoma from reactive seromas in Brazilian patients

Azambuja

Gevert

Oliveira

et al. 2021

Cytometry Part B Clinical

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“… 16 More recently, various groups are assessing the role of flow cytometry analyses in the initial diagnosis and evaluation of breast implant-associated ALCL. 27 – 31 Romero et al 30 published a case series that identified four breast implant-associated ALCL cases out of a total of 39 periprosthetic fluid samples. 30 They identified a statistically significant difference in the percentage of CD30-positive cells between breast implant-associated ALCL and those samples without tumor (54.3% in breast implant-associated ALCL vs. 0.3% in non-tumor; P = .03).…”

Section: Discussionmentioning

confidence: 99%

“…Our flow cytometric findings showed a similar immunophenotype to cases reported in published series and supported the use of an “ungated” CD30/SSC plot in breast implant-associated ALCL diagnosis. 27 , 28 , 30 , 31 However, evaluation of flow cytometric data in a larger number of cases should be undertaken to better establish its role and utility in screening seromas around breast implants. Collection of these data may be facilitated by the preexisting breast implant-associated ALCL databases to encourage research in this still largely underdeveloped field.…”

Section: Discussionmentioning

confidence: 99%

“…[27][28][29][30][31] Romero et al 30 published a case series that identified four breast implant-associated ALCL cases out of a total of 39 periprosthetic fluid samples. 30 They identified a statistically significant difference in the percentage of CD30-positive cells between breast implant-associated ALCL and those samples without tumor (54.3% in breast implant-associated ALCL vs. 0.3% in non-tumor; P = .03). They concluded by recommending consideration of flow cytometry as a first line of analysis over cytopathology in certain contexts.…”

Section: Discussionmentioning

confidence: 99%

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Breast Implanted-Associated Anaplastic Large Cell Lymphoma: A Case of Advanced Disease with Flow Cytometric Findings

et al. 2022

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Breast implant-associated anaplastic large cell lymphoma (breast implant-associated ALCL) is a recently described, distinct clinicopathological entity associated with macrotextured breast implants. The diagnostic workup of a patient suspected to have breast implant-associated ALCL includes cytological assessment of effusions and tissue biopsies of any masses or enlarged lymph nodes, with morphologic and immunophenotypic evaluation and possible flow cytometric and molecular testing. We report the case of a woman found to have breast implant-associated ALCL on fine needle aspirate and core biopsy, who on surgical resection, had extensive local disease with involvement of the resection margins and lymph nodes, requiring systemic treatment. We focus on the flow cytometric findings that identified a population of large cells on the CD30/side scatter dot plot and whose immunophenotype was consistent with breast implant-associated ALCL, highlighting the value of flow cytometry as an adjunct to morphological and immunophenotypic evaluation.

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“…Barr et al pointed that the malignant anaplastic cells in ALCL showed strong CD30 expression, high FSC, and variable SSC, with CD4 expression and reduced/negative expression of other T-cell antigens (73). Despite the presence of reactive CD30 cells, FCM is more sensitive and specific than cytology to distinguish between BIA-ALCL and negative cases (74). Therefore, some studies also proposed that the FCM method should also be regarded as the first-line diagnostic tool.…”

Section: Pathological Diagnosismentioning

confidence: 99%

Current Progress in Breast Implant-Associated Anaplastic Large Cell Lymphoma

et al. 2022

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Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is an uncommon type of T-cell lymphoma. Although with a low incidence, the epidemiological data raised the biosafety and health concerns of breast reconstruction and breast augmentation for BIA-ALCL. Emerging evidence confirms that genetic features, bacterial contamination, chronic inflammation, and textured breast implant are the relevant factors leading to the development of BIA-ALCL. Almost all reported cases with a medical history involve breast implants with a textured surface, which reflects the role of implant surface characteristics in BIA-ALCL. With this review, we expect to highlight the most significant features on etiology, pathogenesis, diagnosis, and therapy of BIA-ALCL, as well as we review the physical characteristics of breast implants and their potential pathogenic effect and hopefully provide a foundation for optimal choice of type of implant with minimal morbidity.

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Should Flow Cytometry Be Considered a First Line of Study in the Diagnosis of Breast Implant–Associated Anaplastic Large-Cell Lymphoma?

Cited by 6 publications

References 8 publications

Use of flow cytometry and cytology to differentiate breast implant‐associated anaplastic large cell lymphoma from reactive seromas in Brazilian patients

Use of flow cytometry and cytology to differentiate breast implant‐associated anaplastic large cell lymphoma from reactive seromas in Brazilian patients

Breast Implanted-Associated Anaplastic Large Cell Lymphoma: A Case of Advanced Disease with Flow Cytometric Findings

Current Progress in Breast Implant-Associated Anaplastic Large Cell Lymphoma

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