ARRS 2022 Abstracts

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1973. Multiple Areas of Architectural Distortion: Patient Characteristics, Imaging Features, and Histopathologic Outcomes
Authors * Denotes Presenting Author
  1. Lilian Wang; Northwestern University
  2. Michelle Philip *; Northwestern University
  3. Sandra Rao; Northwestern University
  4. Sonya Bhole; Northwestern University
  5. David Schacht; Northwestern University
  6. Dipti Gupta; Northwestern University
  7. Rebekah Anders; Northwestern University
Objective:
This study aims to examine patient characteristics and imaging features in patients with 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. Patient demographics (age, breast density, family history, high risk status), lesion characteristics (visibility on DBT vs 2D, DBT size, presence of ultrasound correlate), and pathologic outcome (benign - B, high risk - H, malignant - M) for patients with multiple areas of AD were examined.

Results:
During the study period, there were 441 biopsied AD lesions in 405 patients: 375 patients with a single AD and 66 lesions in 30 patients with multiple ADs. In 30 patients with multiple ADs, 24 had two areas, four had three areas, one had four areas, and one had >four areas. Mean age of patients with multiple ADs was 59.8 years; 24/30 (80%) had dense breasts, 25/30 (83%) had no family history of breast cancer, and 0% were high risk. Mean lesion DBT size was 18.6 mm, 26/66 (39%) of lesions were only seen on DBT vs 2D mammography, and 28/66 (42%) had an ultrasound correlate. Lesion pathology was B in 10/66 (15%), H in 36/66 (55%), and M in 20/66 (30%). Based on most severe pathology per patient, pathology was B in 2/30 (7%), H 16/30 (53%), and M 12/30 (40%). Of patients with two areas of AD, pathology was B in 2/24 (8%), H in 12/24 (50%), and M in 10/24 (42%). In patients with three areas of AD, pathology was H in 2/4 (50%) and M in 2/4 (50%). Patients with >4 areas each had H pathology. Of 30 patients with multiple AD, 19 (63%) had no MRI and 11 (37%) had MRI. Of eleven patients undergoing MRI, 10 (91%) had known malignancy and one had multiple bilateral radial scars. Of the nineteen patients with no MR, two patients had biopsy proven malignancy, fourteen had high risk pathology, and three had benign pathology.

Conclusion:
Of patients with multiple areas of AD, 93% had high risk or malignant pathology and MRI was performed in 37%, mostly for of extent of disease. Management of patients with multiple areas of AD continues to evolve with increased detection due to DBT, with research needed on potential roles of breast MRI and multidisciplinary consultation.