title: Breast Implant-associated Anaplastic Large Cell Lymphoma: Updated Results from a Structured Expert Consultation Process.
abstract: BACKGROUND
  Despite increased cases published on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), important clinical issues remain unanswered. We conducted a second structured expert consultation process to rate statements related to the diagnosis, management, and surveillance of this disease, based on their interpretation of published evidence.
  
  
  METHODS
  A multidisciplinary panel of 12 experts was selected based on nominations from national specialty societies, academic department heads, and recognized researchers in the United States.
  
  
  RESULTS
  Panelists agreed that (1) this disease should be called "BIA-ALCL"; (2) late seromas occurring >1 year after breast implantation should be evaluated via ultrasound, and if a seroma is present, the fluid should be aspirated and sent for culture, cytology, flow cytometry, and cell block to an experienced hematopathologist; (3) surgical removal of the affected implant and capsule (as completely as possible) should occur, which is sufficient to eradicate capsule-confined BIA-ALCL; (4) surveillance should consist of clinical follow-up at least every 6 months for at least 5 years and breast ultrasound yearly for at least 2 years; and (5) BIA-ALCL is generally a biologically indolent disease with a good prognosis, unless it extends beyond the capsule and/or presents as a mass. They firmly disagreed with statements that chemotherapy and radiation therapy should be given to all patients with BIA-ALCL.
  
  
  CONCLUSIONS
  Our assessment yielded consistent results on a number of key, incompletely addressed issues regarding BIA-ALCL, but additional research is needed to support these statement ratings and enhance our understanding of the biology, treatment, and outcomes associated with this disease.
authors: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.
authors: Benjamin
authors: B
authors: Kim
authors: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.
authors: Zachary S
authors: ZS
authors: Predmore
authors: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.
authors: Soeren
authors: S
authors: Mattke
authors: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.
authors: Kristin
authors: K
authors: van Busum
authors: RAND Health, RAND Corporation, Boston, Mass.; Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, Calif.; and Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass.
authors: Courtney A
authors: CA
authors: Gidengil