Breast architectural distortion
Disclosures
- updated 4 Sep 2022:
Nothing to disclose
Updates to Article Attributes
Body
was changed:
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 3:
- contour abnormality
- trabecular thickening
- trabecular disorganisation
Aetiology
Many entities can cause architectural distortion 1,4.In practice, the most common are surgery and malignancy. It is considered the third most common appearance of breast cancer 1,6.
- primary causes
- secondary causes
- postsurgical scars (most common)
- trauma
- infection
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 7-10. Tomosynthesis also helps localizelocalise the abnormality. Targeted ultrasound should then be performed to confirm the finding, but MRI is an alternative if no ultrasound correlate is found 9.
Mammography/US/MRI
Architectural distortion is characterizedcharacterised by a number of possible appearances 5:
- 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 asymmetry, calcifications, or mass. In most cases, architectural distortion is a suspicious finding (BI-RADS 4) 8,9. The BI-RADS Atlas suggests that an ultrasound finding of architectural distortion thought to be due to postsurgical scar may be categorizedcategorised as probably benign (BI-RADS 3), but there is sparse data supporting this approach 5.
See also
- other imaging features of breast malignancy
-<p><strong>Breast architectural distortion</strong> 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.</p><h4>Pathology</h4><p>Architectural distortion is often due to a <a href="/articles/desmoplasia-1">desmoplastic reaction</a> 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 <sup>3</sup>:</p><ul>-<li>contour abnormality</li>-<li>trabecular thickening</li>-<li>trabecular disorganisation</li>-</ul><h5>Aetiology</h5><p>Many entities can cause architectural distortion <sup>1,4</sup>.<sup> </sup>In practice, the most common are surgery and malignancy. It is considered the third most common appearance of <a href="/articles/breast-neoplasms">breast cancer</a> <sup>1,6</sup>.</p><ul>-<li>primary causes<ul>-<li>invasive <a href="/articles/breast-neoplasms">breast cancer</a>, including both <a href="/articles/invasive-lobular-carcinoma-of-the-breast">invasive lobular carcinoma</a> and <a href="/articles/invasive-ductal-carcinoma">invasive ductal carcinoma</a>-</li>-<li><a href="/articles/ductal-carcinoma-in-situ">ductal carcinoma in situ</a></li>-<li>-<a href="/articles/radial-scar">radial scar</a>/<a href="/articles/radial-scar">complex sclerosing lesion</a>-</li>-<li><a href="/articles/fat-necrosis-breast-2">fat necrosis</a></li>-<li><a href="/articles/sclerosing-adenosis-of-the-breast">sclerosing adenosis</a></li>-<li><a href="/articles/fibromatosis-of-the-breast">fibromatosis</a></li>-</ul>-</li>-<li>secondary causes <ul>-<li>-<a href="/articles/post-surgical-breast-scar-1">postsurgical scars</a> (most common)</li>-<li>trauma</li>-<li><a href="/articles/mastitis">infection</a></li>-</ul>-</li>-</ul><h4>Radiographic features</h4><p>Architectural distortion can be visually subtle. Compared to 2D mammography, <a href="/articles/digital-breast-tomosynthesis">digital breast tomosynthesis</a> increases the sensitivity, confidence, and interobserver agreement in detection of architectural distortion <sup>7-10</sup>. 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 <sup>9</sup>.</p><h5>Mammography/US/MRI</h5><p>Architectural distortion is characterized by a number of possible appearances <sup>5</sup>:</p><ul>-<li>radiating thin straight lines or spiculations</li>-<li>focal retraction, distortion, or straightening at the edge of the parenchyma</li>-<li>blurring of normal tissue planes such as the fat-fibroglandular junction</li>-<li>straightening or thickening of <a href="/articles/cooper-ligament">Cooper ligaments</a>-</li>-<li>compression of tissue around a mass</li>-</ul><h4>Radiology report</h4><p>Architectural distortion can be reported as a standalone finding or be associated with (adjacent to) another finding, such as <a href="/articles/asymmetry-mammography">asymmetry</a>, <a href="/articles/breast-calcifications">calcifications</a>, or <a href="/articles/breast-mass">mass</a>. In most cases, architectural distortion is a suspicious finding (<a href="/articles/breast-imaging-reporting-and-data-system-bi-rads-assessment-category-4">BI-RADS 4</a>) <sup>8,</sup><sup>9</sup>. 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 (<a href="/articles/breast-imaging-reporting-and-data-system-bi-rads-assessment-category-3">BI-RADS 3</a>), but there is sparse data supporting this approach <sup>5</sup>.</p><h4>See also</h4><ul><li>other imaging features of breast malignancy<ul>-<li><a href="/articles/breast-mass">masses</a></li>-<li><a href="/articles/asymmetry-mammography">asymmetries</a></li>-<li><a href="/articles/breast-calcifications">calcifications</a></li>-</ul>- +<p><strong>Breast architectural distortion</strong> 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.</p><h4>Pathology</h4><p>Architectural distortion is often due to a <a href="/articles/desmoplasia-1">desmoplastic reaction</a> 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 <sup>3</sup>:</p><ul>
- +<li>contour abnormality</li>
- +<li>trabecular thickening</li>
- +<li>trabecular disorganisation</li>
- +</ul><h5>Aetiology</h5><p>Many entities can cause architectural distortion <sup>1,4</sup>.<sup> </sup>In practice, the most common are surgery and malignancy. It is considered the third most common appearance of <a href="/articles/breast-neoplasms">breast cancer</a> <sup>1,6</sup>.</p><ul>
- +<li>primary causes<ul>
- +<li>invasive <a href="/articles/breast-neoplasms">breast cancer</a>, including both <a href="/articles/invasive-lobular-carcinoma-of-the-breast">invasive lobular carcinoma</a> and <a href="/articles/invasive-breast-carcinoma-of-no-special-type-1">invasive ductal carcinoma</a>
- +</li>
- +<li><a href="/articles/ductal-carcinoma-in-situ">ductal carcinoma in situ</a></li>
- +<li>
- +<a href="/articles/radial-scar">radial scar</a>/<a href="/articles/radial-scar">complex sclerosing lesion</a>
- +</li>
- +<li><a href="/articles/fat-necrosis-breast-2">fat necrosis</a></li>
- +<li><a href="/articles/sclerosing-adenosis-1">sclerosing adenosis</a></li>
- +<li><a href="/articles/fibromatosis-of-the-breast">fibromatosis</a></li>
- +</ul>
- +</li>
- +<li>secondary causes <ul>
- +<li>
- +<a href="/articles/post-surgical-breast-scar-1">postsurgical scars</a> (most common)</li>
- +<li>trauma</li>
- +<li><a href="/articles/mastitis">infection</a></li>
- +</ul>
- +</li>
- +</ul><h4>Radiographic features</h4><p>Architectural distortion can be visually subtle. Compared to 2D mammography, <a href="/articles/digital-breast-tomosynthesis">digital breast tomosynthesis</a> increases the sensitivity, confidence, and interobserver agreement in detection of architectural distortion <sup>7-10</sup>. Tomosynthesis also helps localise the abnormality. Targeted ultrasound should then be performed to confirm the finding, but MRI is an alternative if no ultrasound correlate is found <sup>9</sup>.</p><h5>Mammography/US/MRI</h5><p>Architectural distortion is characterised by a number of possible appearances <sup>5</sup>:</p><ul>
- +<li>radiating thin straight lines or spiculations</li>
- +<li>focal retraction, distortion, or straightening at the edge of the parenchyma</li>
- +<li>blurring of normal tissue planes such as the fat-fibroglandular junction</li>
- +<li>straightening or thickening of <a href="/articles/cooper-ligament">Cooper ligaments</a>
- +</li>
- +<li>compression of tissue around a mass</li>
- +</ul><h4>Radiology report</h4><p>Architectural distortion can be reported as a standalone finding or be associated with (adjacent to) another finding, such as <a href="/articles/asymmetry-mammography">asymmetry</a>, <a href="/articles/breast-calcifications">calcifications</a>, or <a href="/articles/breast-mass">mass</a>. In most cases, architectural distortion is a suspicious finding (<a href="/articles/breast-imaging-reporting-and-data-system-bi-rads-assessment-category-4">BI-RADS 4</a>) <sup>8,</sup><sup>9</sup>. The BI-RADS Atlas suggests that an ultrasound finding of architectural distortion thought to be due to postsurgical scar may be categorised as probably benign (<a href="/articles/breast-imaging-reporting-and-data-system-bi-rads-assessment-category-3">BI-RADS 3</a>), but there is sparse data supporting this approach <sup>5</sup>.</p><h4>See also</h4><ul><li>other imaging features of breast malignancy<ul>
- +<li><a href="/articles/breast-mass">masses</a></li>
- +<li><a href="/articles/asymmetry-mammography">asymmetries</a></li>
- +<li><a href="/articles/breast-calcifications">calcifications</a></li>
- +</ul>
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