What patients need to known about architectural distortion on breast imaging
When a patient receives a radiology report mentioning an "architectural distortion" on their mammogram, it can be a source of concern and confusion. Jessica H. Porembka, MD, FSBI, an associate professor in the breast imaging division at the University of Texas Southwestern Medical Center, and vice chair of strategy and quality, and quality assurance medical director at Parkland Radiology, explains what this term means and its implications for patient care.
What is architectural distortion?
Architectural distortion refers to an abnormality in breast tissue where the normal structure appears pulled or distorted without necessarily forming a distinct mass. The disruption in the pattern of breast tissue usually has a focal point with thread or finger-like projections coming off of it known as spiculations.
"The tissue looks like it's drawn into a point, so there's something that's pulling that tissue together. The spiculations are like threads that come off of it. When we see that, it's concerning. If there is distortion with an underlying mass, that's more concerning for cancer. There are benign things that are not cancer that cause architectural distortion as well, such as radial scars or benign complex sclerosis lesions," Porembka explained.
While architectural distortion can be associated with malignancies, there are also benign causes. However, because cancerous tumors can also cause this pattern by pulling the tissue inward, architectural distortion is generally considered suspicious and requires further evaluation.
What happens after architectural distortion is found?
Porembka emphasizes that when architectural distortion is identified, it usually necessitates additional imaging and often a biopsy to determine the cause. She said if the distortion is something that has been seen on prior mammograms and it does not change is size or shape, physicians might also take a wait and see approach.
In some cases, prior mammograms can provide valuable insight. If the distortion has remained unchanged for several years, especially in a patient with a history of breast surgery or biopsy, it may be due to stable scarring rather than cancer. However, stability over time does not always rule out malignancy, as some slow-growing cancers can initially appear unchanged before eventually progressing, she said.
The role of comparing prior imaging and tomosynthesis
Comparing past breast imaging studies is crucial in assessing architectural distortion.
“Priors are our best friends in breast imaging,” Porembka explained. “If we have mammograms from 10 years ago, we will look at them.”
She said this helps radiologists determine whether an abnormality is new or longstanding and unchanged, which can influence management decisions.
About 50% of patients have dense breast tissue, which appears white on mammograms, the same as cancer. The more dense the tissue, the harder it is to detect cancer or architectural distortions. Advances such as digital breast tomosynthesis (DBT), also known as 3D mammography, allow radiologists to analyze breast tissue layer by layer, reducing the impact of overlapping structures and improving the detection of potential cancers and distortions.
"It can make architectural distortions pop out a little bit easier," she said
DBT imaging systems have seen rapid adoption over the past several years and and now makeup just below 50% of the mammography systems in the United States. As of 2024, 90% of breast imaging centers now have at least one of these 3D breast imaging systems. The technology is replacing older 2D digital mammography systems, and often is used specifically for women known to have dense breasts.
What should patients do?
Patients who see the term “architectural distortion” on their radiology report should follow up with their physician and breast imaging specialist to discuss next steps. If a patient has a history of prior breast surgery, biopsies or family history of breast cancer, they should inform their doctor, as these could explain certain imaging findings. Additionally, patients who change healthcare providers should ensure their past imaging studies are available to the new doctors for comparison with their current mammograms.
For women undergoing routine screening, staying informed and being proactive about breast health can make a significant difference in early diagnosis and treatment. If they have questions, including what certain terms mean on their radiology report, they should raise the questions with their providers if they want to learn more about their clinical assessments.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com