Architectural distortion found on a mammogram
Architectural distortion is a somewhat vague phrase used by radiologists, when the mammogram shows a region where the breasts normal appearance, looks like an abnormal arrangement of tissue strands, often a radial or perhaps a somewhat random pattern, but without any associated mass as the apparent cause of this distortion.
We have a more up-to-date page that has some information on architectural distortion HERE.
The mammogram report will usually ask for some additional work-up, so they call-back the patient to get some extra views or ultrasound or both.
Most of the time, architectural distortion causes some suspicion that there might be cancer. But the radiologist hasn’t confirmed whether a true mass is present yet. Having a ‘mass’ would be even more suspicious.
Architectural distortion could also be the result of benign disease, like a radial scar, or a scar inside the breast from surgery or previous bleeding in the breast. (Old hematomas can end up as scars).
An ultrasound is usually done, it might not find a ‘mass’, but might find an architectural distortion.
What causes the distortion of the architecture inside the breast?
Breast cancer with architectural distortion frequently presents with some kind of fibrosis.
Sometimes architectural distortions are associated with DCIS as well, or, quite often, invasive breast cancers cause an architectural distortion because they stimulate extra fibrosis.
Architectural distortion is among the most common presentations for breast cancer
An architectural distortion may be caused by sclerosing adenosis, or a thing called radial scar, both of which are benign and both quite rare.
Breast cancer commonly causes architectural distortion.
Architectural distortion uncommonly indicates cancer. More common is for architectural distortion to be ‘imaginary’ in the perception of the radiologist.
So in the future, someone will probably classify these into real and imaginary. Just kidding.
Although it is a subtle finding on mammography, architectural distortion is actually the third most common way that breast cancer appears. Mass or Cluster of suspicious microcalcifications are the other major ways that cancer is detected.
References
- Sickles EA. The subtle and atypical mammographic features of invasive lobular carcinoma. Radiology 1991; 178(1):25-6.
- Newstead GM, Baute PB, Toth HK. Invasive lobular and ductal carcinoma: mammographic findings and stage at diagnosis. Radiology 1992; 184(3):623-7.
- Sekine K, Tsunoda-Shimizu H, Kikuchi M, Saida Y, Kawasaki T, Suzuki, K. DCIS showing architectural distortion on the screening mammogram – comparison of mammographic and pathological findings. Breast Cancer (Tokyo, Japan) (2007), 14(3):281-4
- Shaheen R, Schimmelpenninck CA, Stoddart L, Raymond H, Slanetz PJ Spectrum of diseases presenting as architectural distortion on mammography: multimodality radiologic imaging with pathologic correlation. Semin Ultrasound CT MR 2011 Aug; 32(4):351-62.
- Gajdos C, Tartter PI, Bleiweiss IJ, Hermann G, de Csepel J, Estabrook A, Rademaker AW. Mammographic appearance of nonpalpable breast cancer reflects pathologic characteristics. Ann Surg. (Feb. 2002) 235(2):246-51.
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