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Architectural distortion in mammography

The term architectural distortion is a mammographic descriptive term in breast imaging. It may be visualised as tethering or indentation of breast tissue. 

In most patients there is global symmetry between the two breasts as far as the parenchyma is distributed and imaged. By comparing MLO and CC views carefully, subtle areas of asymmetry can be found sometimes even very subtle areas not seen by quick look by by neophyte observers. Parenchymal asymmetry  is a routinely assessed feature in mammography and usually means any undue disruption in the usual parenchymal pattern. It is considered third most-common appearance of breast cancer 1 and at times can be a subtle finding on mammography. The most common etiology in every day practice is post surgical scarring.

Historical note

In times before screening mammography became universally accepted, the diagnosis and surgery for breast pathology was a hapahazard process at best. The diagnosis of carcinoma was invariably made once a tumour was clinically palpbale to the clinician. Surgery was generally performed without preoperative  imaging. The result was that women with benign breast changes would potentially end up with multiple surgeries to both breasts over the course of their lifetime. After  mammography was implemented, it was often impossible to distinguish a postsurgical scar from the architectural distortion caused by the scirrous reaction of a breast cancer. This is the reason why percutaneous needle bioospies are preferred in the eyes of the breast imager and why the demise of the blind open surgical biopsy was a happy day in the eyes of the breast imager.

Pathology

Architectural distortion per se is not a mass. It is often due to a desmoplastic reaction in which there is focal disruption of the normal breast tissue pattern.

There are several features that can be considered as part of architectural distortion. These include 3

  • contour abnormality
  • trabecular thickening
  • trabecular disorganisation
Causes

Many entities can cause architectural distortion 1,4 In practice the most common are surgery and potentially malignant breast lesions. Very subtle lesions are sometimes a feature in lobular breast carcinoma which do not necessarily present with the features usually associated with infiltrating ductal carcinoma (IDC). To this day the most common etiology is the hand of the surgeon.

See also

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