Breast architectural distortion
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Breast architectural distortion is a descriptive term in breast imaging (mammography, ultrasound, and MRI) to indicate that the breast parenchyma is tethered or indented. The finding per se is not a mass.
Architectural distortion 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 3:
- contour abnormality
- trabecular thickening
- trabecular disorganization
Many entities can cause architectural distortion 1,4. In practice, the most common are surgery and malignancy. It is considered the third most common appearance of breast cancer 1,6.
- primary causes
- secondary causes
Architectural distortion can be visually subtle. Compared to 2D mammography, digital breast tomosynthesis increases the sensitivity, confidence, and interobserver agreement in detection of architectural distortion 7-10. Tomosynthesis also helps localize the abnormality. Targeted ultrasound should then be performed to confirm the finding, but MRI is an alternative if no ultrasound correlate is found 9.
Architectural distortion is characterized by a number of possible appearances 5:
- radiating thin straight lines or spiculations
- focal retraction, distortion, or straightening at the edge of the parenchyma
- blurring of normal tissue planes such as the fat-fibroglandular junction
- straightening or thickening of Cooper ligaments
- compression of tissue around a mass
Architectural distortion can be reported as a standalone finding or be associated with (adjacent to) another finding, such as asymmetry, calcifications, or mass. In most cases, architectural distortion is a suspicious finding (BI-RADS 4) 8,9. The BI-RADS Atlas suggests that an ultrasound finding of architectural distortion thought to be due to postsurgical scar may be categorized as probably benign (BI-RADS 3), but there is sparse data supporting this approach 5.
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- 7. Dibble EH, Lourenco AP, Baird GL, Ward RC, Maynard AS, Mainiero MB. Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion. (2018) European radiology. 28 (1): 3-10. doi:10.1007/s00330-017-4968-8 - Pubmed
- 8. Bahl M, Lamb LR, Lehman CD. Pathologic Outcomes of Architectural Distortion on Digital 2D Versus Tomosynthesis Mammography. (2017) AJR. American journal of roentgenology. 209 (5): 1162-1167. doi:10.2214/AJR.17.17979 - Pubmed
- 9. Durand MA, Wang S, Hooley RJ, Raghu M, Philpotts LE. Tomosynthesis-detected Architectural Distortion: Management Algorithm with Radiologic-Pathologic Correlation. (2016) Radiographics : a review publication of the Radiological Society of North America, Inc. 36 (2): 311-21. doi:10.1148/rg.2016150093 - Pubmed
- 10. Partyka L, Lourenco AP, Mainiero MB. Detection of mammographically occult architectural distortion on digital breast tomosynthesis screening: initial clinical experience. (2014) AJR. American journal of roentgenology. 203 (1): 216-22. doi:10.2214/AJR.13.11047 - Pubmed