DCIS showing architectural distortion on the screening mammogram - comparison of mammographic and pathological findings.
BACKGROUND
Patients with mammograms showing architectural distortion often have an invasive carcinoma with noticeable fibrosis, such as scirrhous carcinoma or invasive lobular carcinoma. However, architectural distortion is also seen in some cases of ductal carcinoma in situ (DCIS).


METHODS
Of the 316 patients operated on in our hospital from October 2003 to June 2004, 54 were histopathologically diagnosed as having DCIS (excluding cases with microinvasion). Of these 54 patients, 5 exhibited architectural distortion on the preoperative mammogram. The aim of this study was to correlate the radiologic and pathologic features of DCIS showing architectural distortion on the mammogram.


RESULTS
The mammograms of the 5 patients revealed clusters of calcifications in the architectural distortion. Sclerosis was seen in the interstitium around the DCIS in 3 cases, and DCIS components were found in Cooper's ligament in 4 cases. In 2 cases, sclerosing adenosis was seen in the background of the DCIS.


CONCLUSIONS
It is generally accepted that architectural distortion in DCIS is due to sclerosing adenosis, but sclerosis in the interstitium around the DCIS and presence of DCIS components in Cooper's ligament proved to be the cause of architectural distortion in the cases described here. Since architectural distortion is also seen in DCIS cases, we think that besides the diagnosis of malignancy, the presence or absence of infiltration should be histopathologically established before surgery.
Sekine
Ken
K
Department of Radiology, St.Luke's International Hospital, Tokyo, Japan. kenseki@fork.ocn.ne.jp
Tsunoda-Shimizu
Hiroko
H
Kikuchi
Mari
M
Saida
Yukihisa
Y
Kawasaki
Tomonori
T
Suzuki
Koyu
K
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008327:Mammography / Q000592:standards*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012598:Sclerosis / Q000000981:diagnostic imaging / Q000473:pathology