Diagnostic imaging of Breast Implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Abstract

There are two types of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) : one type presents as a late-onset fluid collection around the implant, and the other type forms a tumor around the implant with a low incidence. Due to these clinical characteristics of BIA-ALCL, accurate diagnosis may be difficult using only mammography or ultrasound. Ultrasound has a high sensitivity for fluid collection, but its specificity is limited, and diagnosis by mammography is difficult because the fluid collection and the tumor are masked by the implant. On the other hand, CT is useful for evaluating chest wall invasion of the tumor, lymph node disease, detection of distant metastases, and staging of the disease. Breast MRI is the most accurate as it allows for the evaluation of the implant's constriction or damage, tissue swelling, fluid presence, and the tumor including small components that cannot be detected by ultrasound. Ultrasound is used as the first line of diagnosis due to its simplicity, and MRI is used as the second line for examination purposes when the diagnosis is uncertain with ultrasound. PET/CT is the first choice for whole-body imaging searches for stage diagnosis, but there may be false positives and false negatives in local diagnosis.