with delayed (>1 year after surgery) peri-implant effusion around a textured implant or surrounding scar capsule, usually occurring 8 to 10 years following implantation with a breast implant for either cosmetic or reconstructive indications [8-10]. Imaging options for implant evaluation include mammography, digital breast tomosynthesis (DBT), US, or MRI. However, saline implant rupture is usually clinically apparent, with diagnosis made by physical examination. Special Imaging Considerations PET/CT: For confirmed cases of BIA-ALCL, a PET scan is often beneficial for demonstrating capsular masses or chest wall involvement and is the preferred test to evaluate for systemic spread to regional or distant lymph nodes and/or organ involvement [11]. Active BIA-ALCL is positive on a PET scan [11]. On PET, BIA-ALCL demonstrates moderate fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG) uptake in associated effusion or as a moderate-high focal uptake relating to masses located at the external implant fibrous capsule [12]. In addition, locally advanced disease demonstrates increased uptake beyond the capsule and is evident in involved lymph nodes [12]. FDG-PET is therefore useful for local staging as well as for disease surveillance [12]. There are; however, clinically important nuances with the use of PET/CT for evaluating BIA-ALCL. The metabolic component of PET/CT does not allow determination of whether a peri-implant effusion is benign or lymphoma related, because the cell density within the fluid is too low for an effective positron signal to be detected (ie, PET/CT does not allow distinction of benign from malignant effusions); this can result in a false-negative PET interpretation [13]. Inflammatory activity is normally observed surrounding a breast implant capsule (owing to FDG uptake by activated macrophages and granulation tissue), which can lead to a false-positive PET interpretation and confound peri- implant mass component assessment [13].
Breast Implant Evaluation. with delayed (>1 year after surgery) peri-implant effusion around a textured implant or surrounding scar capsule, usually occurring 8 to 10 years following implantation with a breast implant for either cosmetic or reconstructive indications [8-10]. Imaging options for implant evaluation include mammography, digital breast tomosynthesis (DBT), US, or MRI. However, saline implant rupture is usually clinically apparent, with diagnosis made by physical examination. Special Imaging Considerations PET/CT: For confirmed cases of BIA-ALCL, a PET scan is often beneficial for demonstrating capsular masses or chest wall involvement and is the preferred test to evaluate for systemic spread to regional or distant lymph nodes and/or organ involvement [11]. Active BIA-ALCL is positive on a PET scan [11]. On PET, BIA-ALCL demonstrates moderate fluorine-18-2-fluoro-2-deoxy-D-glucose (FDG) uptake in associated effusion or as a moderate-high focal uptake relating to masses located at the external implant fibrous capsule [12]. In addition, locally advanced disease demonstrates increased uptake beyond the capsule and is evident in involved lymph nodes [12]. FDG-PET is therefore useful for local staging as well as for disease surveillance [12]. There are; however, clinically important nuances with the use of PET/CT for evaluating BIA-ALCL. The metabolic component of PET/CT does not allow determination of whether a peri-implant effusion is benign or lymphoma related, because the cell density within the fluid is too low for an effective positron signal to be detected (ie, PET/CT does not allow distinction of benign from malignant effusions); this can result in a false-negative PET interpretation [13]. Inflammatory activity is normally observed surrounding a breast implant capsule (owing to FDG uptake by activated macrophages and granulation tissue), which can lead to a false-positive PET interpretation and confound peri- implant mass component assessment [13].