Study Reveals Safe Alternatives to Surgical Excision
Recent findings published in the American Journal of Roentgenology (AJR) suggest that imaging surveillance may be a safe alternative to surgical excision for certain architectural distortions (ADs) detected by digital breast tomosynthesis (DBT). This applies specifically to ADs with no sonographic correlate that show benign pathology without atypia on core needle biopsy (CNB).
The groundbreaking research, led by Dr. Derek L. Nguyen from Duke University School of Medicine’s radiology department, revealed a striking difference in malignancy rates between different types of architectural distortions.
“The malignancy rate was 0% for ADs without atypia, versus 20% for ADs with atypia, on CNB,” explained Dr. Nguyen, highlighting the significance of these findings for breast imaging protocols.
Comprehensive Study Methodology
The research team conducted a thorough investigation focusing on patients with ADs detected exclusively by digital breast tomosynthesis between July 1, 2020, and December 31, 2023. Key inclusion criteria were:
- Architectural distortions detected by DBT alone
- No ultrasound correlate present
- Nonmalignant results on stereotactic CNB
- 12 vacuum-assisted 9-gauge cores used for sampling
This methodical approach ensured consistent evaluation across all cases, strengthening the reliability of the findings for clinical application.
Tailored Management Recommendations
Based on biopsy findings, the research team implemented differentiated management protocols:
For ADs Without Atypia:
Patients with concordant benign pathology or radial scar without atypia on CNB were recommended to undergo:
- 6-month diagnostic imaging follow-up
- 12-month diagnostic imaging follow-up
- Return to annual screening thereafter
For ADs With Atypia:
Patients showing atypia (with or without radial scar) on CNB were recommended to undergo surgical excision.
While these protocols were recommended, patients had the option to choose alternative management approaches based on personal preference or other clinical factors.
Significant Clinical Implications
The study’s final analysis delivered compelling evidence that could transform breast imaging protocols. For ADs detected by DBT alone with no ultrasound correlate and nonmalignant results on CNB (using 12 vacuum-assisted 9-gauge samples), the results were definitive:
- 0% malignancy rate (0/94) in the absence of atypia (with or without radial scar)
- 20% malignancy rate (3/15) in the presence of atypia (with or without radial scar)
These findings strongly support the possibility of using imaging surveillance rather than immediate surgical intervention for certain architectural distortions, potentially reducing unnecessary surgeries while maintaining patient safety.
Advancing Breast Imaging Protocols
This research represents a significant advancement in breast imaging protocols, offering evidence-based guidance for managing architectural distortions detected by digital breast tomosynthesis. The clear distinction in malignancy rates between ADs with and without atypia provides radiologists and breast surgeons with valuable information for clinical decision-making.
By identifying which architectural distortions can be safely monitored through imaging surveillance rather than surgical excision, healthcare providers can potentially reduce unnecessary procedures while ensuring appropriate care for those with higher-risk findings.
This patient-centered approach to managing architectural distortions detected by DBT aligns with broader efforts to optimize breast cancer screening and diagnosis, balancing the need for thorough evaluation with considerations of patient comfort and healthcare resource utilization.
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