How do you diagnose BIA-ALCL?

Written by Board Certified Plastic Surgeon Nima Naghshineh, MD, FACS on July 8th, 2020.

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According to the 2019 NCCN Consensus Guidelines on the Diagnosis and Treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) the following has been suggested for diagnosis:

First, seek out an experienced surgeon with expertise in breast and reconstruction. Your plastic surgeon maybe able to determine without imaging whether you have a fluid collection in your breast. He or she may also notice a mass during the examination or skin changes such as a rash or an ulceration.

I often will get an ultrasound or an MRI which may help in finding a pocket of fluid and obtaining a sample from that pocket of fluid. That pocket of fluid typically called seroma or an effusion can be aspirated and the fluid should be sent for laboratory analysis. If there is a mass in question, a larger needle may be able to get a sample or your plastic surgeon may make a small incision to get a sample of the mass.

Plastic surgeon needs to order very specific exams to rule out BIA-ALCL. It is critical that the correct tests or ordered and not every lab can perform them. If the results come back negative, then you treat it as a benign or normal fluid collection. If there is confirmation of the disease, then a treatment plan is created with the help of several other doctors (see Treating BIA-ALCL article).