ARRS 2022 Abstracts

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1191. Single Versus Multiple Areas of Architectural Distortion: Patient Characteristics and Pathologic Outcomes
Authors * Denotes Presenting Author
  1. Lilian Wang *; Northwestern University
  2. Rebekah Anders; Northwestern University
  3. Sandra Rao; Northwestern University
  4. Sonya Bhole; Northwestern University
  5. Dipti Gupta; Northwestern University
  6. Sarah Friedewald; Northwestern University
  7. Michelle Philip; Northwestern University
Objective:
This study aims to compare patient characteristics and pathologic outcomes for single versus multiple areas of architectural distortion (AD) identified on digital breast tomosynthesis (DBT) undergoing image-guided biopsy.

Materials and Methods:
A retrospective review of patients undergoing image-guided biopsy of AD without associated mammographic mass or asymmetry between 4/2017 and 4/2019 was performed. Single vs multiple AD groups were compared in terms of patient demographics (age, breast density, family history, high risk status), lesion characteristics (visibility on DBT vs 2D, DBT size, presence of ultrasound [US] correlate), and pathologic outcome (benign - B, high risk - H, malignant - M) per lesion and per patient (most severe pathology).

Results:
A total of 456 areas of suspicious AD were identified in 417 patients. Twelve patients were excluded (7 for biopsy cancellation, 5 for lack of DBT images). In the multiple AD group, 3 lesions were not biopsied due to proximity to other biopsied areas. Overall, there were 441 biopsied AD lesions in 405 patients: 375 patients with single AD (145 B, 122 H, 108 M) and 66 lesions (10 B, 36 H, 20 M) in 30 patients with multiple AD. Of patients with multiple AD, 24 patients had 2 areas and 6 had >3 areas. When comparing patients with single and multiple ADs, there was no significant difference in age, breast density, family history, or high risk status (p>0.05). On lesion analysis, multiple AD lesions were significantly more likely to be smaller in size (mean size 19 mm vs 24 mm, P<0.01) and visible only on DBT vs 2D (41% vs 27%, p=0.02), whereas no significant difference was seen for presence of US correlate (p=0.51). Malignant and high risk pathology were significantly more likely with multiple than single AD, on a per lesion (85% vs 61%, p<0.01) and per patient basis (93% vs 61%, p<0.01). MRI was significantly more likely to be performed in patients with multiple than single AD (37% vs 12%, p<0.01).

Conclusion:
High-risk or malignant pathology is significantly more likely in patients with multiple than single AD, resulting in complex patient management decisions. Further research is needed to define management guidelines including roles for MRI and multidisciplinary consultation.