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Detection of Architectural Distortion in Prior Mammograms via Analysis of Oriented Patterns
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Architectural Distortion on Digital Breast Tomosynthesis: Management Algorithm and Pathological Outcome.

Naziya Samreen1, Linda Moy2, Cindy S Lee1

  • 1NYU Langone Medical Center, Department of Radiology, Garden City, NY.

Journal of Breast Imaging
|March 1, 2024
PubMed
Summary

Digital breast tomosynthesis (DBT) detects more architectural distortions than 2D mammography. While many are benign, suspicious findings warrant biopsy, with malignancy rates up to 50.7%.

Keywords:
architectural distortionbreast MRIbreast cancerdigital breast tomosynthesisultrasound

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Area of Science:

  • Radiology
  • Oncology
  • Pathology

Background:

  • Architectural distortion on mammograms can stem from benign or malignant sources.
  • Digital breast tomosynthesis (DBT) improves detection of architectural distortion compared to 2D mammography.

Purpose of the Study:

  • To analyze the diagnostic workup, pathological outcomes, and management of architectural distortion detected with DBT.
  • To evaluate the concordance between imaging findings and pathology for architectural distortion.

Main Methods:

  • Review of cases with architectural distortion on DBT.
  • Correlation of imaging findings with ultrasound, MRI, and percutaneous biopsy results.
  • Pathological analysis of biopsy specimens.

Main Results:

  • DBT increases architectural distortion detection, with a high positive predictive value necessitating biopsy.
  • Malignancy rates range from 6.8% to 50.7%, most commonly invasive ductal carcinoma.
  • Radial scars are the most frequent benign cause; concordance is key, as discordant findings have a 25% upgrade rate.

Conclusions:

  • Architectural distortion on DBT requires a tailored workup including ultrasound, MRI, and biopsy.
  • Discordant radiologic-pathologic findings warrant surgical consultation due to potential for malignancy upstaging.