Breast architectural distortion

Last revised by Andrew Murphy on 23 Mar 2023

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.

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 asymmetrycalcifications, 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.

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: sclerosing adenosis
    Drag here to reorder.
  • Case 2: invasive ductal carcinoma
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.