E1601. Core Biopsy Proven Benign Architectural Distortions of the Female Breast: Is Additional Follow-up Imaging or Surgical Excision Needed?
  1. Jason Shames; Thomas Jefferson University
  2. Riti Kanesa-thasan; Thomas Jefferson University
  3. Jeffrey Landy; Thomas Jefferson University
  4. Kimberly Klinger; Thomas Jefferson University
  5. Julia Kahn; Cooper University
  6. Pauline Germaine; Cooper University
  7. Lisa Zorn; Thomas Jefferson University
The ability to detect and biopsy mammographic architectural distortions (AD) has greatly improved with routine utilization of digital breast tomosynthesis (DBT) and DBT-guided core biopsy. Given the absence of a published treatment algorithm for ADs and their known high association with high-risk (HRL) and malignant lesions, inconsistencies with concordance and follow-up recommendations of benign ADs after DBT-guided core biopsy can occur. This retrospective study specifically set out to evaluate the surgical excision and/or two-year follow-up outcomes of benign ADs to support the development of an outcome-based management algorithm for DBT-guided biopsied ADs.

Materials and Methods:
IRB approved multi-institution retrospective review of women with ADs from 01/01/2016-3/18/2020 was performed. Inclusion criteria were women over the age of 18 with a mammographically confirmed AD that subsequently underwent an image-guided core biopsy. Subsequent surgical excision or 2-year of imaging follow-up were used to confirm core biopsy results. Associated mammographic or sonographic findings were assessed to determine factors that could influence the probability an AD was associated with a HR or malignant lesion.

During the IRB approved time-frame, 144 patients were identified having both an AD and subsequent image-guided core biopsy, which resulted in 55 benign (38%), 59 HR (41%), and 30 malignant (21%) lesions. The percent of HR or malignant ADs on core biopsy was 62%, compatible with previously published data of 67%. Benignity was proven by excisional biopsy or 2-years of imaging stability for 17 patients, with 4 being upgraded to HR lesions and 1 being upgraded to malignancy for an upgrade rate of 9%. The pre-test probability for a HR or malignant lesion if the AD was associated with a sonographic mass or distortion was 62%, and 61% if associated with a mammographic mass, asymmetry, focal asymmetry or calcifications.

DBT and DBT-guided core biopsy offer radiologists enhanced ability to detect and sample ADs. Current findings suggest benign ADs may benefit from proceeding to excisional biopsy, especially if associated with sonographic or mammographic findings. To mitigate potential bias and increase statistical power of this two institution observation, an expanded multi-institutional study is vital to generate a safe management algorithm of image-guided biopsy proven benign ADs.