Tomosynthesis-detected Architectural Distortion: Management Algorithm with Radiologic-Pathologic Correlation

Area of Science:

• Radiology
• Breast Imaging
• Oncology

Background:

• Digital breast tomosynthesis (DBT) is increasingly used, revealing suspicious lesions not seen on 2D mammography.
• Architectural distortion, a key indicator of malignancy, is detected more frequently with DBT.
• Optimal management of DBT-detected architectural distortions remains undefined.

Purpose of the Study:

• To outline practical methods for assessing architectural distortions identified by DBT.
• To propose a management algorithm for tomosynthesis-detected architectural distortions.

Main Methods:

• Utilizing DBT localization tools and enhanced visualization for identifying subtle distortions.
• Employing focused ultrasonography (US) and magnetic resonance imaging (MRI) for diagnosis and biopsy guidance.
• Considering tomosynthesis-guided biopsy, stereotactic biopsy, or needle localization for tissue diagnosis.

Main Results:

• DBT significantly increases the detection of architectural distortions compared to 2D mammography.
• Integrated imaging approaches (DBT, US, MRI) aid in the evaluation and biopsy of these lesions.
• A proposed algorithm facilitates the management of tomosynthesis-detected architectural distortions.

Conclusions:

• DBT enhances the detection of architectural distortions, necessitating refined management protocols.
• A systematic approach involving advanced imaging and biopsy techniques improves diagnostic yield.
• The proposed algorithm offers a framework for managing these challenging mammographic findings.