Related Experiment Video
Updated: Jul 3, 2026
Detection of Architectural Distortion in Prior Mammograms via Analysis of Oriented Patterns
Published on: August 30, 2013
Visibility patterns of architectural distortion on synthesized 2D vs. digital breast tomosynthesis and their
Cedric Pluguez-Turull1, Niki Nourmohammadi2, Bo Li3
1Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, United States of America.
Background:
Architectural distortion (AD) is a subtle but clinically important mammographic finding. With the adoption of synthesized 2D mammography (s2D) and digital breast tomosynthesis (DBT), AD detection has increased, often with a reduced positive predictive value for malignancy.
Purpose:
To evaluate AD visibility on s2D versus DBT, assess its predictive value for malignancy compared with benign or high-risk lesions, assess interreader agreement, and analyze biopsy outcomes based on visibility.
Methods:
This retrospective study included 297 BI-RADS 4 or 5 AD cases detected on combined s2D + DBT mammography (2017-2018). Three breast radiologists independently assessed AD visibility on s2D and DBT. Pathologic outcomes were categorized as malignant, high-risk, or benign. Visibility patterns were correlated with pathology, positive predictive values (PPVs) were calculated by subgroup, and interreader agreement was assessed using Cohen's kappa.
Results:
Of 297 architectural distortion (AD) cases, 33% were malignant (99/297), 30% high-risk (89/297), and 37% benign (109/297), yielding an overall PPV of 33%. When analyzed by visibility group, 23.1% of DBT-only ADs were malignant compared with 50.5% of ADs visible on at least one synthesized 2D (s2D) view (p < 0.001). Benign outcomes were significantly associated with decreasing s2D visibility (p = 0.03), whereas malignancy showed no significant association with increasing s2D + DBT visibility (p = 0.93). s2D-visible ADs demonstrated higher and more consistent PPVs for malignancy (approximately 48-54%) compared with DBT-only ADs (approximately 21-25%). Interreader agreement was moderate for s2D (κ = 0.46) and fair for DBT-only ADs (κ = 0.38).
Conclusion:
Architectural distortion visible on s2D and DBT is associated with a higher likelihood of malignancy than DBT-only distortion; however, the nontrivial malignancy rate of DBT-only lesions limits the reliability of pre-biopsy visibility as a standalone discriminator. While DBT enhances detection, it also increases biopsies of benign and high-risk lesions, highlighting the essential role of radiologic-pathologic correlation in management decisions.
