0:01

Lastly,

0:01

I would like to briefly talk about the breast implant or associated anaplastic

0:05

large large cell lymphoma.

0:09

So it is a real T-cell lymphoma or non-Hodgkin's lymphoma.

0:14

The instance is very, very low,

0:18

and that is not recognized as a new entity by

0:23

W H O until 2016,

0:26

but because of the data is limited,

0:28

so our knowledge on this is still evolving

0:34

in a lot of report, saying that it's more commonly inpatient with a texture.

0:39

The implant patient can present,

0:42

present with symptoms of a tight means pain or lung or swelling of the breast.

0:47

So while, while the, uh, per implant fluid develop,

0:51

it can occur months or years after the, uh, surgery,

0:57

but make sure that the patient has no erythema warmth or skin

1:02

thickening with that symptoms, uh, patient can have, uh, either infection,

1:06

inflammation, and or inflammatory breast cancer.

1:12

So we need to be very careful when we evaluate this patient's symptoms.

1:18

Early recognition is important and, uh, it can be diagnosed.

1:23

So with, uh, fluid analysis of your aspirate,

1:27

some perim implant fluid

1:30

and management should be complete. Uh, surgical incision of the, uh,

1:36

accurate diagnosis depends on the stage, uh, systemic, um,

1:42

chemotherapy and radiation. Um, radiation therapy

1:47

can also be used for this patients, I believe.

1:51

This is the last question.

1:53

What's the most appropriate initial imaging recommendation for suspected breast

1:58

implant or associated cancer by acr?

2:05

The correct answer is, uh, actually, uh, d

2:10

what ultrasound, uh,

2:12

is recommended for patient of any age with any type of implant and no loss of

2:17

you choose, uh, uh,

2:18

a I think you practice in real world practice.

2:23

Lots of a physician just ordered m r i. Anyway,

2:29

so let's take a look at the ACR appropriateness criteria over here.

2:35

Over here. So that is the, uh, a c appropriateness criteria.

2:40

I directly copy from the, uh, website. They say that,

2:45

uh, um, just us uh, ultrasound breast,

2:49

it should be the initial imaging evaluation for

2:54

the, uh, patient with, uh, with the suspected, um,

2:59

A anaplastic large cell lymphoma,

3:02

regardless of a patient's age or implant type. Yeah.

3:07

For ultrasound is procal or non diagnostic.

3:10

You can confirm the M R I because like, uh,

3:13

we just talked about very often those, uh,

3:17

anaplastic large cell lymphoma presented as a perim implant fluid.

3:20

When you detect on the ultrasound,

3:22

you will do the ultrasound guided aspiration and thes for fluid diagnosis.

3:27

Right? Uh, if the results come back as negative, you still, you know,

3:32

concerned about the, um, lymphoma you then,

3:35

that you can perform an m r i with without contrast because

3:40

sometimes, uh, um, this, uh, lymphoma can present as a,

3:44

as a mass, which can be detected on the m r I with without contrast.