Architectural Distortion of the Breast: Imaging Approach and Management

Architectural distortion (AD) of the breast is a problematic imaging finding because it is difficult to perceive since it mimics the fibroglandular tissue. AD is the third most common form of presentation of breast cancer in mammography, only preceded by masses and calcifications. Once AD is detected and determined to be a candidate for a biopsy, it is necessary to know the biopsy options available, with the preferred biopsy method being image-guided biopsy. Furthermore, the differential diagnosis for AD is broad, and it is crucial to perform pathology-radiological correlation post-biopsy.

There is controversy regarding the management of AD when the histopathological diagnosis is a radial scar or complex sclerosing lesion. An option for management includes recommendations based on the size of the lesion and the presence or absence of atypia.

This article will review the spectrum of imaging presentation of breast AD, biopsy recommendations, and management options.