Editorial Comment: Appropriate Management of Architectural Distortion Detected on Digital Breast Tomosynthesis

2020 ◽  
Author(s):  
Melissa Angeline Durand
Keyword(s):  
Editorial Comment ◽  
Digital Breast Tomosynthesis ◽  
Architectural Distortion ◽  
Breast Tomosynthesis

Architectural Distortion on Digital Breast Tomosynthesis: Management Algorithm and Pathological Outcome

2020 ◽  
Vol 2 (5) ◽  
pp. 424-435
Author(s):  
Naziya Samreen ◽  
Linda Moy ◽  
Cindy S Lee
Keyword(s):  
Digital Mammography ◽  
Ductal Carcinoma ◽  
Lobular Carcinoma ◽  
Digital Breast Tomosynthesis ◽  
Percutaneous Biopsy ◽  
Architectural Distortion ◽  
Imaging Findings ◽  
Breast Tomosynthesis ◽  
Management Algorithm

Abstract Architectural distortion on digital breast tomosynthesis (DBT) can occur due to benign and malignant causes. With DBT, there is an increase in the detection of architectural distortion compared with 2D digital mammography, and the positive predictive value is high enough to justify tissue sampling when imaging findings are confirmed. Workup involves supplemental DBT views and ultrasound, with subsequent image-guided percutaneous biopsy using the modality on which it is best visualized. If architectural distortion is subtle and/or questionable on diagnostic imaging, MRI may be performed for problem solving, with subsequent biopsy of suspicious findings using MRI or DBT guidance, respectively. If no suspicious findings are noted on MRI, a six-month follow-up DBT may be performed. On pathology, malignant cases are noted in 6.8%–50.7% of the cases, most commonly due to invasive ductal carcinoma, followed by invasive lobular carcinoma. Radial scars are the most common benign cause, with stromal fibrosis and sclerosing adenosis being much less common. As there is an increase in the number of benign pathological outcomes for architectural distortion on DBT compared with 2D digital mammography, concordance should be based on the level of suspicion of imaging findings. As discordant cases have upgrade rates of up to 25%, surgical consultation is recommended for discordant radiologic-pathologic findings.

A cross-cutting approach for tracking architectural distortion locii on digital breast tomosynthesis slices

2019 ◽  
Vol 50 ◽  
pp. 92-102 ◽  
Author(s):  
Helder C.R. de Oliveira ◽  
Arianna Mencattini ◽  
Paola Casti ◽  
Juliana H. Catani ◽  
Nestor de Barros ◽  
...  
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Architectural Distortion ◽  
Breast Tomosynthesis

scholarly journals Diagnostic accuracy of digital breast tomosynthesis in combination with 2D mammography for the characterisation of mammographic abnormalities

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Vithya Visalatchi Sanmugasiva ◽  
Marlina Tanty Ramli Hamid ◽  
Farhana Fadzli ◽  
Faizatul Izza Rozalli ◽  
Chai Hong Yeong ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Breast Imaging ◽  
Digital Breast Tomosynthesis ◽  
Asian Population ◽  
Architectural Distortion ◽  
Breast Lesions ◽  
Cross Sectional ◽  
Breast Tomosynthesis ◽  
Full Field

AbstractThis study aims to assess the diagnostic accuracy of digital breast tomosynthesis in combination with full field digital mammography (DBT + FFDM) in the charaterisation of Breast Imaging-reporting and Data System (BI-RADS) category 3, 4 and 5 lesions. Retrospective cross-sectional study of 390 patients with BI-RADS 3, 4 and 5 mammography with available histopathology examination results were recruited from in a single center of a multi-ethnic Asian population. 2 readers independently reported the FFDM and DBT images and classified lesions detected (mass, calcifications, asymmetric density and architectural distortion) based on American College of Radiology-BI-RADS lexicon. Of the 390 patients recruited, 182 malignancies were reported. Positive predictive value (PPV) of cancer was 46.7%. The PPV in BI-RADS 4a, 4b, 4c and 5 were 6.0%, 38.3%, 68.9%, and 93.1%, respectively. Among all the cancers, 76% presented as masses, 4% as calcifications and 20% as asymmetry. An additional of 4% of cancers were detected on ultrasound. The sensitivity, specificity, PPV and NPV of mass lesions detected on DBT + FFDM were 93.8%, 85.1%, 88.8% and 91.5%, respectively. The PPV for calcification is 61.6% and asymmetry is 60.7%. 81.6% of cancer detected were invasive and 13.3% were in-situ type. Our study showed that DBT is proven to be an effective tool in the diagnosis and characterization of breast lesions and supports the current body of literature that states that integrating DBT to FFDM allows good characterization of breast lesions and accurate diagnosis of cancer.

Comparison of digital mammography and digital breast tomosynthesis in the detection of architectural distortion

2017 ◽  
Vol 28 (1) ◽  
pp. 3-10 ◽  
Author(s):  
Elizabeth H. Dibble ◽  
Ana P. Lourenco ◽  
Grayson L. Baird ◽  
Robert C. Ward ◽  
A. Stanley Maynard ◽  
...  
Keyword(s):  
Digital Mammography ◽  
Digital Breast Tomosynthesis ◽  
Architectural Distortion ◽  
Breast Tomosynthesis

scholarly journals Is Digital Breast Tomosynthesis Superior to Digital Mammography? A Preclinical Evaluation of Tumor Histopathological Markers Using Digital Breast Tomosynthesis

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Aysegul Altunkeser ◽  
Zeynep Fatma Arslan ◽  
Mehmet Ali Eryilmaz ◽  
Muslu Kazım Korez ◽  
Zeynep Bayramoğlu
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Mass Density ◽  
Digital Breast Tomosynthesis ◽  
Molecular Classification ◽  
Architectural Distortion ◽  
Ki 67 ◽  
Breast Tomosynthesis ◽  
Skin Changes ◽  
The Relationship

Background: Digital mammography (DM) and digital breast tomosynthesis (DBT) are important radiological modalities, which increase the survival of breast cancer patients. Breast cancer is a morphologically heterogeneous disease with various histopathological parameters and multiple receptors in its biological profile. Objectives: This study aimed to analyze the morphological features of invasive breast cancer on DM and DBT, to investigate the contribution of DBT to DM, to examine the association of DBT findings with pathological molecular subtypes, Bloom-Richardson grade, and Ki-67 index, and to determine the effect of breast parenchyma density on the relationship between DBT findings and hormone receptors. Patients and Methods: A total of 36 patients with malignant lesions were evaluated in this study. According to the American College of Radiology (ACR) classification, the lesion features were divided into subgroups based on DM and DBT, and the findings were compared. The relationships between DBT findings and the hormone receptor status, molecular classification, and Bloom-Richardson grade were also investigated, and the effect of density on these relationships was assessed. Results: The mean age of the patients (n = 36) was 53 years. Based on the comparison of DM and DBT findings, spiculated margins, mass density, architectural distortion, and microcalcifications were significantly more frequent in DBT. Lesions with indistinct margins on DM were observed as mass lesions with spiculated margins on DBT (P < 0.001). Regarding the relationship between DBT findings and hormone receptor status and Ki-67 proliferation index, in PR-positive patients, an irregular tumor shape was more common (89.7%). In PR-negative patients, skin changes and nipple retraction were more frequently seen (P = 0.03 for skin changes, and P = 0.049 for nipple retraction). Regarding the association between Bloom-Richardson grade and DBT findings, tumors with a higher grade were more likely to be associated with a high tumor density (P = 0.032). Also, considering the relationship between molecular classification and DBT findings, skin changes and nipple retraction were significantly more frequent in triple-negative masses compared to other subtypes (P = 0.011 for skin changes and P = 0.016 for nipple retraction). Conclusions: DBT is superior to DM, as it reveals the lesion margins, density, and architectural distortion more accurately. The majority of PR-positive tumors were irregular, while most PR-negative cases were round. The mass density also increased as the tumor grade increased. Skin change and nipple retraction were frequently seen in triple-negative tumors compared to other subtypes. Therefore, DBT is a promising diagnostic tool for showing molecular subtypes in dense breasts.

scholarly journals Architectural Distortion on Screening Digital Breast Tomosynthesis: Pathologic Outcomes and Indicators of Malignancy

2020 ◽  
Author(s):  
Anubha Wadhwa ◽  
Shadie S Majidi ◽  
Solomon Cherian ◽  
Daniel S Dykstra ◽  
Sarah G Deitch ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Univariate Analysis ◽  
Digital Breast Tomosynthesis ◽  
Inverse Correlation ◽  
Screening Mammography ◽  
Architectural Distortion ◽  
Breast Tomosynthesis ◽  
High Risk Factors ◽  
Imaging Characteristics

Abstract Objective Digital breast tomosynthesis (DBT) has significantly improved cancer detection capabilities through its identification of subtle findings often imperceptible on 2D digital mammography, particularly architectural distortion (AD). The purpose of this study was to analyze of suspicious AD detected on screening DBT to evaluate the incidence of malignancy and to determine other patient or imaging characteristics in these cases as possible predictors of malignancy. Methods This was an IRB approved retrospective analysis of subjects with AD detected on DBT screening mammography who were given a biopsy recommendation between January 1, 2016, and June 30, 2018. Univariate analysis of various imaging characteristics and patient high-risk factors was performed for statistical correlation with diagnosis of malignancy. Results In the 218 DBT-detected AD findings with a final BI-RADS assessment of 4 or 5 on diagnostic workup, 94 (43.1%) yielded malignancy, 57 (26.2%) were classified as high-risk, and 67 (30.7%) were benign. There was a strong statistically significant association with malignancy in the cases with an US correlate (P &lt; 0.0001). There was a statistically significant inverse correlation between malignancy and one-view findings (P = 0.0002). The presence of AD on 2D (P = 0.005) or synthetic 2D views (P = 0.002) showed statistically significant correlations with malignancy, whereas breast density or high-risk factors (P = 0.316) did not. Conclusion AD detected on DBT that persists on further workup and has no explainable cause should be considered suspicious for malignancy. Identification of the AD on both standard mammographic views and the presence of an US correlate significantly increase the probability of malignancy.

Architectural Distortion (Radial Scar)

2018 ◽  
Author(s):  
Reni S. Butler
Keyword(s):  
Digital Breast Tomosynthesis ◽  
Radial Scar ◽  
Architectural Distortion ◽  
Imaging Features ◽  
Imaging Evaluation ◽  
Breast Tomosynthesis ◽  
Complex Sclerosing Lesion ◽  
High Risk Lesion ◽  
Histological Confirmation ◽  
Management Recommendations

Radial scars are benign lesions of the breast characterized pathologically by a fibroelastic core containing entrapped ducts and lobules that radiate outwards in a stellate pattern. This chapter, highlighting radial scar as a cause of architectural distortion, reviews its imaging features and differential diagnosis on mammography, digital breast tomosynthesis, ultrasound, and MRI; its diagnostic workup using multiple modalities; and its histological confirmation with image-guided core needle biopsy. The particular challenge of radial scar presenting as architectural distortion seen only with tomosynthesis is discussed, along with an algorithm for imaging evaluation and biopsy guidance in this setting. As radial scar, which is histologically related to complex sclerosing lesion and radial sclerosing lesion, is considered a high-risk lesion, management recommendations are also reviewed.

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