PURPOSE To provide guidelines for the accurate pathologic diagnosis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), the preoperative evaluation of the patient with suspected BIA-ALCL, and the pathologic evaluation of the capsulectomy specimen. METHODS To better inform patients and healthcare providers about BIA-ALCL, we convened to review diagnostic procedures used in the evaluation of patients with suspected BIA-ALCL. We focused on the processing of the seroma fluid/effusion surrounding the implant, the handling of capsulectomy specimens following removal of implant(s), and the preoperative evaluation of the patient with suspected BIA-ALCL. Recommendations were based on the published literature and our experience to optimize procedures to obtain an accurate diagnosis and assess for tumor invasion and the extent of the disease. RECOMMENDATIONS Early diagnosis of BIA-ALCL is important as the disease can progress and deaths have been reported. Because the most common presentation of BIA-ALCL is swelling of the breast with fluid collection, an accurate diagnosis requires cytologic evaluation of the effusion fluid surrounding the affected implant. The first priority is cytocentrifugation and filtration of fresh, unfixed effusion fluid to produce air-dried smears that are stained with Wright-Giemsa or other Romanowsky-type stains. Preparation of a cell block is desirable to allow for hematoxylin and eosin staining and immunohistochemical analysis of formalin-fixed, paraffin-embedded histologic sections. Cell block sections can be used for polymerase chain reaction-based investigation of T-cell receptor gene rearrangement to detect clonality. Fixation and mapping of the capsulectomy specimen to select multiple representative sections are advised to assess for microscopic tumor involvement and capsular invasion. It is appropriate to assess lymph node involvement by excisional biopsy material rather than fine needle aspiration, due to propensity for focal involvement.

中文翻译：

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乳房植入相关的间变性大细胞淋巴瘤病理诊断最佳实践指南

目的 为乳房植入物相关间变性大细胞淋巴瘤（BIA-ALCL）的准确病理诊断、疑似 BIA-ALCL 患者的术前评估以及囊切除标本的病理评估提供指南。方法 为了更好地向患者和医疗保健提供者通报 BIA-ALCL，我们召开会议审查了用于评估疑似 BIA-ALCL 患者的诊断程序。我们重点关注植入物周围血清液/渗出液的处理、植入物移除后囊切除标本的处理以及疑似 BIA-ALCL 患者的术前评估。建议基于已发表的文献和我们优化程序的经验，以获得准确的诊断并评估肿瘤侵袭和疾病的程度。建议 BIA-ALCL 的早期诊断非常重要，因为该疾病可能会进展，并且已有死亡报道。由于 BIA-ALCL 最常见的表现是乳房肿胀并伴有积液，因此准确的诊断需要对受影响的植入物周围的渗出液进行细胞学评估。首要任务是对新鲜的、未固定的渗出液进行细胞离心和过滤，以产生风干涂片，并用赖特-吉姆萨或其他罗曼诺夫斯基型染色剂染色。需要制备细胞块，以便对福尔马林固定、石蜡包埋的组织切片进行苏木精和伊红染色以及免疫组织化学分析。细胞块切片可用于基于聚合酶链反应的 T 细胞受体基因重排研究，以检测克隆性。建议对囊切除术标本进行固定和标测，以选择多个有代表性的切片，以评估显微肿瘤受累和囊侵犯。由于局部受累的倾向，通过切除活检材料而不是细针抽吸来评估淋巴结受累是合适的。