Summation Tissues Simulating Architectural Distortion

Chapter 55 –

Chapter 56 –

Radial Scar, Surgical Scar

Chapter 57 –

Invasive Lobular Carcinoma

Architectural distortion is the third most common imaging characteristic, aside from mass and calcification, which may indicate breast cancer. Architectural distortion is the most elusive, as it can be confused with overlapping tissues, which is inherent in a two-dimensional image of a three-dimensional object, the breast. The criteria to look for are straight lines in a radiating or spoke-wheel pattern and sharp angulated edges.

Remember—there are no naturally occurring straight lines in the body! So always closely evaluate any image, regardless of body organ, with straight lines.

The perception of “architectural distortion” is the same for spiculated margins; the only difference is that the former lacks a central density. As you progress through the chapters of possible architectural distortion, benign radial and surgical scars, and then malignancy, Chapters 55, 56, and 57, respectively, notice how similar the mammographic findings appear regardless of outcome. Therefore, since architectural distortion represents malignancy more frequently than benignity, the definitive presence of this feature, having ruled out surgical scar, trauma, and infection, always warrants a biopsy.

Use caution in patients with a prior history of breast surgery. Anecdotally, the author has seen several cases in which there was a delay in diagnosis of breast cancer where the architectural distortion/spiculated mass was assumed to be the surgical scar. Whenever possible, look at the preoperative films showing the target lesion and its location and, if possible, the wire localization films to know the location of the surgical site. These images are important to determine where a surgical scar is expected to be when evaluating an area of architectural distortion. Some surgeons “tunnel” under the skin to the lesion, making their incision circumareolar for optimal cosmetic results. Therefore, the location of the scar on the skin of the breast may not reflect the location of the surgical excision.

CHAPTER 55: SUMMATION TISSUES SIMULATING ARCHITECTURAL DISTORTION

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