RESUMO
Recent UK guidelines recommend that surveillance imaging should not be offered to patients who have undergone treatment for breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) unless clinically indicated. The aim of this study was to explore the evolving practice at a tertiary referral unit and quantify the direct economic costs (DEC) associated with post-treatment BIA-ALCL routine radiological surveillance prior to adoption of the guidelines. Eleven patients were treated for BIA-ALCL between 2015 and 2020. At a median follow-up of 38 months (IQR 12-47) there were no local or distant relapses. Two patients did not have any radiological surveillance and 1 had follow-up elsewhere. The remaining 8 patients had a combination of positron emission tomography/computed tomography (PET/CT) (n = 10), CT (n = 2), breast ultrasound (n = 6), mammogram (n = 4) and breast magnetic resonance imaging (MRI) (n = 1) as routine imaging follow-up not guided by clinical concerns. Total cost of imaging was £10,396 (12,257) with a median cost of £1953 (2304) per patient [IQR £526-2029 (621-2394)]. This cost could have been saved based on current guidelines recommending no routine surveillance for asymptomatic patients.
Assuntos
Implantes de Mama , Neoplasias da Mama , Linfoma Anaplásico de Células Grandes , Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/etiologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/etiologia , Linfoma Anaplásico de Células Grandes/terapia , Imageamento por Ressonância Magnética/métodos , Recidiva Local de Neoplasia/etiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia ComputadorizadaAssuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Neuroimagem/métodos , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias Cerebelares/diagnóstico por imagem , Neoplasias Cerebelares/patologia , Colina/análogos & derivados , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma não Hodgkin/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Compostos RadiofarmacêuticosRESUMO
We present the case of a patient diagnosed with hairy cell leukaemia (HCL) who subsequently developed biopsy confirmed bone lesions and underwent multiple lines of therapy. The reported incidence of bone lesions in HCL is 3%, and bony involvement can be associated with high tumour burden and aggressive disease. The commonly lytic bone lesions in HCL are difficult to accurately assess for response. Whole body diffusion weighted imaging (WB-DWI) has been used clinically in multiple myeloma; we postulate clinical utility in HCL, where hypercellularity also applies. In our case, WB-DWI appears to discriminate sites of active disease from bone response. We present the salient radiological and pathological images. To our knowledge, this is the first description of WB-DWI in HCL; we support research of WB-DWI in the staging, prognostication and response assessment of HCL.
