title: Architectural Distortion on Mammography: Correlation With Pathologic Outcomes and Predictors of Malignancy.
abstract: OBJECTIVE
  The objective of our study was to determine the risk of malignancy associated with architectural distortion and to evaluate the imaging and clinical features that may contribute to the prediction of malignancy in the setting of architectural distortion.
  
  
  METHODS
  We performed a retrospective review of architectural distortion cases from January 1, 2004, to December 31, 2013. Imaging findings and pathology outcomes were reviewed.
  
  
  RESULTS
  Over the 10-year study period, architectural distortion that was considered to be suspicious for or highly suggestive of malignancy was present in 435 of 231,051 (0.2%) mammographic examinations. Cases were excluded if the main finding described was a mass with an associated feature of architectural distortion (n = 62) or if no pathology results were available (n = 4). Two hundred seventy-five cases of invasive adenocarcinoma or ductal carcinoma in situ (DCIS) were identified; the positive predictive value (PPV) was therefore 74.5% (275/369). DCIS alone was identified in only 4.1% (15/369). The most common benign finding on pathology was a radial scar or complex sclerosing lesion (27/369, 7.3%). Architectural distortion was less likely to represent malignancy on screening mammography than on diagnostic mammography (67.0% vs 83.1%, respectively; p < 0.001). Architectural distortion without a sonographic correlate was less likely to represent malignancy than architectural distortion with a correlate (27.9% vs 82.9%, respectively; p < 0.001). There was no statistically significant difference in the malignancy rate between pure architectural distortion and architectural distortion with calcifications or asymmetries (73.0% vs 78.8%; p = 0.26).
  
  
  CONCLUSIONS
  The PPV of architectural distortion for malignancy is 74.5%. Architectural distortion is less likely to represent malignancy if detected on screening mammography than on diagnostic mammography or if there is no sonographic correlate.
authors.affiliation: 1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
authors.forename: Manisha
authors.initials: M
authors.lastname: Bahl
authors.affiliation: 1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
authors.forename: Jay A
authors.initials: JA
authors.lastname: Baker
authors.affiliation: 2 Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Emily N
authors.initials: EN
authors.lastname: Kinsey
authors.affiliation: 1 Department of Radiology, Division of Breast Imaging, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710.
authors.forename: Sujata V
authors.initials: SV
authors.lastname: Ghate
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment
keywords: architectural distortion; breast; mammography