A 42-year-old woman presents for baseline screening mammography and a combination digital breast tomosynthesis study is performed. She has a positive family history for breast cancer. 

Dense glandular tissue is noted on mammography, as well as an area of architectural distortion in the left breast. This is best demonstrated on digital breast tomosynthesis (arrows).

The architectural distortion on digital breast tomosynthesis was imaged with ultrasound and a 1.0 cm hypoechoic mass was identified.  

A 12-gauge vacuum assisted ultrasound guided breast biopsy was recommended.

Results: Invasive carcinoma with ductal and lobular features

: This case demonstrates the value added by digital breast tomosynthesis (DBT) to breast cancer screening. Due to the technology’s capability of allowing cross-sectional visualization of breast tissue, the difficulty caused by overlapping tissue can be reduced. Because of this, DBT’s ability to render lesions more visible is most evident for masses, asymmetries, and areas of architectural distortion.

Gur D, Abrams GS, Chough DM, et al. Digital Breast Tomosynthesis: Observer Performance Study. AJR 2009; 193:586–591.

Rafferty EA, Park JM, Philpotts LE, et al. Assessing Radiologist Performance Using Combined Digital Mammography and Breast Tomosynthesis Compared with Digital Mammography Alone: Results of a Multicenter, Multireader Trial. Radiology 2013; 266: 104-113.

Image IQ: 42-year-old with Architectural Distortion on Breast Tomo