Architectural Distortion on Screening Digital Breast Tomosynthesis: Pathologic Outcomes and Indicators of Malignancy

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Digital breast tomosynthesis (DBT) enhances cancer detection over 2D mammography, particularly for subtle findings like architectural distortion (AD).
• Architectural distortion (AD) is a challenging mammographic finding that can indicate malignancy.

Purpose of the Study:

• To evaluate the malignancy incidence of suspicious architectural distortion (AD) detected on screening DBT.
• To identify patient or imaging characteristics that predict malignancy in cases of AD detected via DBT.

Main Methods:

• Retrospective analysis of screening DBT mammograms with biopsy-recommended AD between January 2016 and June 2018.
• Univariate analysis of imaging characteristics and patient high-risk factors correlated with final malignancy diagnosis.

Main Results:

• Of 218 cases with BI-RADS 4 or 5 AD, 43.1% were malignant. Malignancy showed strong correlation with ultrasound (US) findings (P < 0.0001).
• Malignancy inversely correlated with one-view findings (P = 0.0002). AD presence on 2D or synthetic 2D views correlated with malignancy (P = 0.005, P = 0.002).
• Breast density and high-risk factors did not significantly correlate with malignancy (P = 0.316).

Conclusions:

• Suspicious architectural distortion (AD) on DBT that persists and lacks a clear benign cause warrants evaluation for malignancy.
• Malignancy probability increases with AD identification on standard mammographic views and the presence of US correlation.