Architectural distortion in mammography

Architectural distortion is a mammographic descriptive term in breast imaging. It may be visualized as tethering or indentation of breast tissue.

Architectural distortion per se is not a mass. It 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 disorganization

Many entities can cause architectural distortion 1,4. In practice, the most common are surgery and potentially malignant breast lesions. Very subtle lesions are sometimes a feature in lobular breast carcinoma, which does not necessarily present with the features usually associated with infiltrating ductal carcinoma (IDC).

In most patients, there is global symmetry between the two breasts as far as the parenchyma is distributed and imaged. By comparing MLO and CC views carefully, subtle areas of asymmetry can be found that are sometimes not seen on quick look by neophyte observers. Parenchymal asymmetry is a routinely assessed feature in mammography and usually means any undue disruption in the usual parenchymal pattern.

It is considered as the third most-common appearance of breast cancer 1 and at times can be a subtle finding on mammography.

In times before screening mammography became universally accepted, the diagnosis and surgery for breast pathology was a haphazard process at best. The diagnosis of carcinoma was invariably made once a tumor was clinically palpable to the clinician. Surgery was generally performed without preoperative imaging. The result was that women with benign breast changes would potentially end up with multiple surgeries to both breasts over the course of their lifetime. After mammography was implemented, it was often impossible to distinguish a postsurgical scar from the architectural distortion caused by the scirrhous reaction of a breast cancer. This is the reason why percutaneous needle biopsies are preferred in the eyes of the breast imager and why the demise of the blind open surgical biopsy was a happy day in the eyes of the breast imager.

Breast imaging and pathology
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Article information

rID: 15462
System: Breast, Oncology
Section: Gamuts
Synonyms or Alternate Spellings:
  • Architectural distortion
  • Mammographic architectural distortion
  • Breast architectural distortion

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Cases and figures

  • Case 1: sclerosing adenosis
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  • Case 2: invasive ductal carcinoma
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