BIA-ALCL diagnosis: the relevance of cytology and flow cytometry in periprosthetic fluid analysis.

IF 0.4
Radu Chiriac, Marie Donzel, Lucile Baseggio
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Abstract

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare T-cell non-Hodgkin lymphoma, representing less than 1% of breast neoplasms. Despite its low incidence, the increasing number of women with breast implants necessitates vigilance among clinicians and pathologists. BIA-ALCL presents in situ and invasive forms, with varying prognoses. The National Comprehensive Cancer Network guidelines recommend cytology, immunohistochemistry, and flow cytometry (FCM) for diagnosis. This retrospective study analyzed 16 periprosthetic fluid (PF) samples from suspected lymphoma cases between January 2018 and January 2024. Cytological and immunological analyses were performed using May Grünwald-Giemsa staining, and FCM with BD FACSCanto II and BD LYRIC cytometers. A 10 or 12-colour FCM panel including pan-T markers and CD30 was used. Of the 16 samples, 2 cases were diagnosed with BIA-ALCL. BIA-ALCL cases showed atypical CD4+ T-cells with large size and loss of CD3 and CD7. In contrast, the 14 reactive cases did not exhibit atypical cells. Key challenges included sample volume limitations, cell dilution, and distinguishing neoplastic cells from reactive ones, particularly in cases with low cell counts. FCM, combined with an extensive panel of pan-T markers and CD30, effectively differentiates anaplastic BIA-ALCL cells from reactive seroma. However, it should complement, not replace, traditional diagnostic methods. Recognizing pitfalls and correlating FCM findings with clinical and morphological data enhances diagnostic accuracy. FCM is a valuable tool for diagnosing BIA-ALCL but should be used alongside other methods. Accurate diagnosis depends on understanding sample-specific challenges and integrating FCM results with clinical context.

BIA-ALCL诊断:细胞学和流式细胞术在假体周围液分析中的相关性。
乳房植入物相关间变性大细胞淋巴瘤(BIA-ALCL)是一种罕见的t细胞非霍奇金淋巴瘤,占乳腺肿瘤的不到1%。尽管发病率很低,但越来越多的女性乳房植入物需要警惕临床医生和病理学家。BIA-ALCL表现为原位和侵袭性,预后不同。国家综合癌症网络指南推荐细胞学、免疫组织化学和流式细胞术(FCM)进行诊断。本回顾性研究分析了2018年1月至2024年1月间16例疑似淋巴瘤患者的假体周围液(PF)样本。细胞学和免疫学分析采用May gr nwald- giemsa染色,FCM采用BD FACSCanto II和BD LYRIC细胞仪。使用10或12色FCM面板,包括pan-T标记物和CD30。16例病例中,2例诊断为BIA-ALCL。BIA-ALCL患者表现为非典型CD4+ t细胞,体积大,CD3和CD7缺失。相比之下,14例反应性病例未表现出非典型细胞。主要挑战包括样本量限制、细胞稀释、区分肿瘤细胞和活性细胞,特别是在细胞计数低的情况下。流式细胞术结合广泛的泛t标记物和CD30,可有效区分间变性BIA-ALCL细胞和反应性血清肿。然而,它应该补充而不是取代传统的诊断方法。识别缺陷并将FCM结果与临床和形态学数据相关联可以提高诊断的准确性。流式细胞仪是诊断BIA-ALCL的一种有价值的工具,但应与其他方法一起使用。准确的诊断取决于对样本特异性挑战的理解,并将FCM结果与临床背景相结合。
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