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Topic: Interpreting Mammograms: Architectural Distortion

Forum: Not Diagnosed But Worried —

Meet others worried about developing breast cancer for the first time. PLEASE DO NOT POST PICTURES OF YOUR SYMPTOMS. Comparing notes, symptoms, or characteristics is not helpful here, as only medical professionals can accurately evaluate and assess your individual situation.

Posted on: Aug 6, 2017 05:59AM

djmammo wrote:

from the American College of Radiology Breast Imaging Boot Camp

(ligaments referred to are Cooper's Ligaments part of the support structure of normal breast tissue)


Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Posts 31 - 58 (58 total)

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Jun 9, 2019 02:32PM Schweety wrote:

Is there such a thing as a mammography guided biopsy? 

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Jun 9, 2019 03:23PM - edited Jun 9, 2019 03:24PM by Beesie

Just replied to your same question in another thread.

Yes, it's a stereotactic biopsy. I provided a link with more information in my other post.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Jun 10, 2019 08:41AM - edited Jun 10, 2019 08:43AM by Trying2staypositive

For arch distortion, I was told yes there a way to biopsy that using mammo. I have the arch distortion also but first having a biospy on microcalcifications W mammo, but for the arch distortion in another area they said in my case they will likely do my biopsy by mri. It cannot be seen on US so cant use US in my case. Maybe in my case harder to see so mri over mammo. Not sure.

Dx 7/15/2019, ILC, Left, Grade 2, ER+/PR+, HER2- Surgery 9/10/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jun 10, 2019 10:48AM Schweety wrote:

Beesie…. it is supposed to be a hollow needle core biopsy.

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Jun 10, 2019 11:22AM djmammo wrote:

Yes there are mammogram guided biopsies. As mentioned above, they are called stereotactic biopsies. They are usually done on a dedicated machine where you lie on your stomach. Newer 3D mammo units can have a attachment to do these either sitting or standing up.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jun 10, 2019 11:53AM Trying2staypositive wrote:

My stereotactic biopsy is by mammo sitting up. I thought the sitting up was weird. Better to know its probably a newer machine then! Makes sense as itsa new facility.

Dx 7/15/2019, ILC, Left, Grade 2, ER+/PR+, HER2- Surgery 9/10/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jun 10, 2019 02:42PM Beesie wrote:

I've had several stereotactic biopsies over the past 15 years, at a couple of different facilities, and they were always done sitting up. Reading on this site about the ones done lying down, I was always glad to be sitting comfortably (well, relatively comfortably, considering that my breast was in a vice), facing the nurses and the Radiologists, who would always talk to me to keep me calm and keep my focus off the procedure. And with one that went very long (the Radiologist had difficulty accessing the calcifications), the nurse held a juice box so that I could have some sustenance.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Jun 11, 2019 10:50AM Schweety wrote:

The both of my stereotactic biopsies I had I were on my belly with my breast in a hole and they were done that way. The Ultrasound guided hollow needle core, I was on my back for of them. 

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Jun 12, 2019 10:43AM Trying2staypositive wrote:

Beesie-good to know. The juice box made me laugh! Love it-need some levity about now. I get my biopsy “sitting up” next thurs. for some microcalcifications. They did a 3D mammo (my first 3D I think only had 2d done before this at a diff facility). So I assume its 3d for the biopsy and prob using the attachment djmammo is referring to. I also get my mri for another breast issue on the same side, diff location (a distortion) the day before because my period messed up the original schedule (showed up early).

Oh how none of this waiting and worrying is good. If it wasnt for my family history (breast cancer plus ADH and just some benign fibrocystic changes) as well as my “heterogeneously dense breasts”, I might not be AS worried. Hard to say. Ive been getting the dense breast disclaimer for years and have confirmed fibrocystic changes on that side as of 10 years ago. (My only other breast mri ever) Sigh....

Dx 7/15/2019, ILC, Left, Grade 2, ER+/PR+, HER2- Surgery 9/10/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jun 12, 2019 02:36PM Trying2staypositive wrote:

Now they called me and moved my MRI to next month (July) because they want to see both the arch distortion plus the area they will mark with the biopsy next week (microcalcifications) at the same time. Doesnt make a ton of sense to me but...ok? I mean the biopy results will be known a week after biopsy, so why look at it again several weeks later when looking at the arch distortion? Weird. I mean theoretically they should know if its an issue way before then? Guess it doesnt matter except way more waiting.

Dx 7/15/2019, ILC, Left, Grade 2, ER+/PR+, HER2- Surgery 9/10/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jun 12, 2019 03:30PM - edited Jun 13, 2019 11:49AM by runor

This Post was deleted by runor.
Dx 3/23/2017, IDC, Left, 2cm, Stage IIB, Grade 2, 0/1 nodes, ER+/PR+, HER2- Surgery 4/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Radiation Therapy 7/5/2017 Whole-breast: Breast Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 19, 2019 06:09PM footballmomma wrote:

Question about architectual distortion: Since the imaging technology is so good now, will we start to see more people getting the architectual distortion label on their screening mammograms?

This is what I have as of now. I went to see the BS a couple of weeks ago and looking at my mammos and u/s couldn't even really see what the radiologist was seeing. The BS surgeon looked at my breast with the u/s machine in her office, but nothing stood out to her. I had my stereo this morning. I am hoping for best obviously, but prepping for the worst as I have a strong family history.

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Jun 20, 2019 05:58AM djmammo wrote:

footballmomma

One of the touted features of "3D" mammos is it's increased ability to detect architectural distortion. As with any new technology, the over-calling of findings will level out after a while.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Jun 20, 2019 09:22AM footballmomma wrote:

I know that since I am going through this process it would be best to stay off the internet, but that is proving hard for me. I read that 75% of AD come back malignant. Is AD the new early indicator of cancer with the new technology? I have a strong family history so I am aware of what might be headed my way after my biopsy results next week. AD was a new term to me and the first radiologist I saw had a hard time explaining it.

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Jun 20, 2019 11:23AM Trying2staypositive wrote:

Footballmama-I have the same finding after a 3d mammo. Did you have your stereotactic biopsy on a 3d machine? Or something else?

Dx 7/15/2019, ILC, Left, Grade 2, ER+/PR+, HER2- Surgery 9/10/2019 Lymph node removal: Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement
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Jun 20, 2019 12:49PM djmammo wrote:

Footballmama

AD is not a new concept nor a new term. Picture a smooth bed sheet on a bed. Then place a heavy weight on it for a few moments and then remove it. You will have a smooth bed sheet with a focal area of wrinkling in the center that looks different from its surroundings. That's AD.

For example: IDC develops into the classic spiculated or stellate (star shaped) mass. The area of distortion is in part the irregular margin of the tumor and in part the body's reaction to the tumor called the desmoplastic reaction. Together they look like that bed sheet that got crinkled up in one spot. It can be the earliest sign that something is going on in the breast before a definite mass is seen on a routine 2D mammo in a dense breast.

Since the 3D units can display the breast as a series of slices analogous to but not exactly like a CT scan, the AD can be better demonstrated in dense breasts.

I am not sure if that 75% you quoted reflects the new 3D or the old 2D technology but I would say the vast majority of AD that can be visualized as a mass on US will be malignant. The ones that cannot be seen on US usually turn out to be a radial scar in my experience.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 13, 2020 07:01PM scaredmominmi wrote:

I am a 40 year old who just went for my first mammogram this past month. The mammogram identified a spot on my left breast, which then resulted in a follow up ultrasound and mammogram. They are now sending me for a biopsy next week.

They noted an architectural distortion in my left breast in an area that I had aspirated (it was a cyst) twice in my late 20s. Is there still a chance that this is benign and related to that cyst? How long does it normally take to get the results of the biopsy? I am a nervous wreck and a mom of two young kiddos who need me.

Thank you for your help.

Dx with 1.3cm complex sclerosing lesion (CSL) on 2/29/20. Awaiting surgery to confirm benign CSL. 40 years old. Mom to an 8 year old and 10 year old.
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Feb 13, 2020 10:08PM djmammo wrote:

scaredmominmi

Can you post the ultrasound report?

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 14, 2020 07:51AM scaredmominmi wrote:

The ultrasound report says this: A focal area of architectural distortion persists within the upper outer quadrant of the left breast. This measures approximate 1.3cm in maximal dimension. The remaining breast parenchyma is unremarkable.

Ultrasound of the left breast demonstrates an ill-defined hypoechoic maaa with associated posterior shadowing at the 12 o'clock position posterity. This measures 1.3x0.8x0.8 cm sonographically. The surrounding breast parenchyma is unremarkable.

BI-RADs 4: Suspicious abnormality. Biopsy should be considered.

Breast composition C: Heterogeneously dense.

Dx with 1.3cm complex sclerosing lesion (CSL) on 2/29/20. Awaiting surgery to confirm benign CSL. 40 years old. Mom to an 8 year old and 10 year old.
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Feb 14, 2020 09:29AM djmammo wrote:

scaredmominmi

The architectural distortion would not be related to a prior cyst aspiration.

The US findings of an irregular mass with posterior shadowing makes this suspicious for IDC. A biopsy will tell the story.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 14, 2020 09:39AM scaredmominmi wrote:

Thanks for the quick response, djmammo. Is there a high likelihood it is cancer from that reading?

Dx with 1.3cm complex sclerosing lesion (CSL) on 2/29/20. Awaiting surgery to confirm benign CSL. 40 years old. Mom to an 8 year old and 10 year old.
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Feb 14, 2020 09:43AM djmammo wrote:

scaredmominmi

I consider that this particular description indicates a high likelihood.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 14, 2020 09:52AM scaredmominmi wrote:

Thanks. I feel like this just came out of nowhere since I'm so young (40). How quickly will they be able to identify my prognosis and stage of cancer? This isn't a death sentence, right?

Dx with 1.3cm complex sclerosing lesion (CSL) on 2/29/20. Awaiting surgery to confirm benign CSL. 40 years old. Mom to an 8 year old and 10 year old.
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Feb 14, 2020 12:39PM - edited Feb 20, 2020 02:38PM by djmammo

scaredmominmi

The biopsy will tell the grade of the tumor, examination of the lumpectomy specimen will give additional information. Stage will be determined by lymph node sampling at surgery and by imaging of other parts of the body perhaps by PET scan.

In general cancers measuring 1.4cm and under have the best prognosis if nodes are negative.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 20, 2020 02:24PM scaredmominmi wrote:

Went through a third round of ultrasounds/mammograms at a top hospital near me. Had a biopsy where they took 7 samples. It came back benign, but they are recommending that I see a surgeon to have what they are calling a radial scar removed. They did not think there is a chance of cancer. Should I still be worried? Do you know how much of the breast they remove when this happens? I see a surgeon in a week and a half. Thank you so much!

Dx with 1.3cm complex sclerosing lesion (CSL) on 2/29/20. Awaiting surgery to confirm benign CSL. 40 years old. Mom to an 8 year old and 10 year old.
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Feb 20, 2020 02:41PM djmammo wrote:

scaredmominmi

All radial scars are removed as there is a very small chance of malignancy associated with them. I assume they might get up to a 1cm margin around it but your surgeon can answer that more accurately for you.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Feb 20, 2020 02:45PM scaredmominmi wrote:

Thanks so much, djmammo. Do you know what the urgency is on this kind of surgery? Do they want patients to do it asap, or can it wait a few months?

Dx with 1.3cm complex sclerosing lesion (CSL) on 2/29/20. Awaiting surgery to confirm benign CSL. 40 years old. Mom to an 8 year old and 10 year old.
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Jul 19, 2020 08:08PM - edited Jul 19, 2020 08:11PM by Fitmomoftwo

Gosh, I hope this is still an active thread. My name is Ashley and I actually posted on another forum on this site but it occurred to me that this would be a good place to also post to see if you could give me your opinion? It is greatly appreciated.🙏🏻


• 6 months ago: persistent Architectural Distortion on 2D and 3D Mammo. No Ultrasound correlate. Biopsy done with benign findings.

Here is the report from 6 months ago:

"The findings are benign. Fibrocystic changes could be a reason for the architectural distortion but these results are technically nonspecific. Surgical consultation is recommended for possible excision. At minimum, short term follow up in 6 months"

The benign pathology 6 months ago was apocrine metaplasia, microcysts, and Usual Ductal Hyperplasia.

Q: What does it mean if my biopsy results are “non-specific" to the area of concern? (The AD) Does that mean it does not correlate?

3 days ago I proceeded with an excisional surgery to remove the 1cm area of AD & surrounding tissue. Just curious on what your second opinion Is on this?

• Present day:

@ 6 month follow up 6/29/2020:
1cm AD was re-identified in same spot at the 3:00 o' clock position medially, with biopsy clip close to it. Ultrasound noted a 4x4x4mm cyst with obscured margins also at the 3:00 position but was deemed non-suspicious on report. Sent to breast surgeon to discuss these findings upon recommendation.

Wide excision 7/16

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