Architectural distortion

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.

Pathology

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 :

  • contour abnormality
  • trabecular thickening
  • trabecular disorganization
Etiology

Many entities can cause architectural distortion .In practice, the most common are surgery and malignancy. It is considered the third most common appearance of breast cancer .

Radiographic features

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 . 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 .

Mammography/US/MRI

Architectural distortion is characterized by a number of possible appearances :

  • 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

Radiology report

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) . 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 .

See also

Siehe auch: