Anaplastic Large Cell Lymphoma Associated with Breast Implants

A look at the rising incidence of breast implant-associated anaplastic large cell lymphoma while detailing key indications, strengths, and limitations of the available imaging techniques.

Course ID: Q00634 Category:
Modalities: , , , , , ,


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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


  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


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