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Architectural distortion on digital breast tomosynthesis with non-malignant pathology

February 3, 2022 — According to an article in the American Journal of Roentgenology (AJR) from the ARRS, imaging monitoring is an alternative management option for architectural distortions on digital breast tomosynthesis (DBT) yielding a radial scar without atypia and other concordant benign pathologies without atypia on biopsy.

“To our knowledge,” asserted co-authors Juan Villa Camacho and Manisha Bahl of Massachusetts General Hospital in Boston, “this investigation represents the largest study of non-malignant architectural distortion on DBT.”

Defining architectural distortion as parenchymal distortion with no visible mass, Camacho and Bahl’s retrospective study included cases of architectural distortion detected by mammography from July 1, 2016 to June 30, 2019 that were non-malignant on biopsy at the image-guided needle and underwent surgical excision. Mammographic examinations included both 2D digital mammography and DBT. With imaging data extracted from radiology reports, upgrade rates were summarized using descriptive statistics.

The overall rate of upgrading from architectural distortion on DBT with concordant findings from non-malignant pathology at biopsy to malignancy at surgery was 10.2% (13/128). The rate of progression to malignancy for architectural deformity without atypia on biopsy was 2.2% (2/89) and for architectural deformity with atypia was 28.2% (11/39).

Noting that, historically, surgery has been recommended for all cases of architectural distortion, including cases not malignant at biopsy, “our results suggest that imaging surveillance rather than surgery may be considered for radial scars without atypia. and other benign concordant pathologies without atypia,” the couple concluded.

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