Q. I went for a mammogram, and it shows architectural distortion. Why?

Answered by
Dr. Satyajit Jalinder Pawar
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 30, 2021

Hi doctor,

I went for my mammogram today, and this was just posted to my portal. Need help better understanding. I am a 39-year-old asymptomatic female for routine screening mammography. There is a family history of breast cancer in her maternal grandmother. Lifetime estimated risk of breast cancer 24.4 %. Digital breast tomosynthesis of each breast was performed in the CC, and MLO projections, two-dimensional, synthetic CC, and MLO views were photographed and reviewed. The last clinical breast exam was two years ago. Impression three years ago, the internal architecture of both breasts demonstrated almost entirely fatty tissue, volpara, and BI-RADS breast density category A. There is focal asymmetry with questionable associated architectural distortion in the posterior depth left outer breast, not evident on the prior exams. Allowing for the difference in technique, no other suspected interval change. There are no suspicious masses, no suspicious clusters of microcalcification, nor any evidence of skin thickening, nipple retraction, or any other questionable architectural distortion identified. CAD was utilized and reviewed. Benign-appearing axillary lymph nodes were noted bilaterally. Impression of test two years ago is focal asymmetry with questionable associated architectural distortion in the posterior depth left outer breast. We will contact the patient to return for additional left breast imaging, beginning with spot compression digital breast tomosynthesis in the CC and MLO projections. Additional mammographic views or targeted breast ultrasound will follow, if necessary. According to ACR appropriateness criteria, patients with greater than 20% lifetime risk of breast cancer are recommended to undergo annual screening breast MRI as a supplement to mammography. As a result, the patient was provided a pamphlet with information regarding screening breast MRI examinations. BI-RADS 0: Needs additional evaluation. Please note that a negative mammogram does not exclude malignancy, particularly in the presence of a palpable mass. The false-negative rate of mammography is in the range of 10-15% in patients with fatty breasts. I am attaching the report.

Kindly give your opinion.



Welcome to

I have gone through your mammogram report (attachments removed to protect the patient's identity). I would like to know what exactly you need help with. I will explain the report in short for you.

1) We calculate the lifetime risk of breast cancer by various formulas. For a normal asymptomatic woman, it is around 12.5%, and for her, mammogram screening is enough. For a woman with a risk of more than 20% MRI (magnetic resonance imaging) is preferred as it is more sensitive and can pick up cancers early (as in your case).

2) In your report, there is mention of architectural distortion in the left breast, which was not seen in a previous mammogram three years ago. This could be just due to technical differences but can also be a starting of malignancy which needs to be confirmed with additional mammography views like spot compression (as mentioned in your report) to rule out the possibility of cancer.

3) Young women, as in your case, have dense breasts (reported as ACR (albumin: creatinine ratio) category), which can actually hide small tumors, so a breast ultrasound is usually done to rule out or resolve any possible suspicious lesion on a mammogram.

Because of these reasons, you will be called back for re-evaluation before going with the final report. Your report finally mentions BI-RADS : 0 (breast imaging reporting and database system score), which is a reporting system for mammograms where 0 means the test is incomplete and needs further evaluation.

If you have any other questions, you can always revert back here. I hope this was helpful.

Hi doctor,

Thank you.

Would this be an early stage if it ends up being cancer? Kindly give your opinion.



Welcome back to

Yes, this would be a very early stage, even if this ends up being cancer. The report does not mention the approximate size of that abnormal area. But if it is less than 2 cm which appears to be the case, then it will be stage: 1 cancer.

But before that, we need to be sure of the nature of that lesion, which would be determined after additional mammograms and USG (ultrasonography). If it appears suspicious or malignant, you will undergo a needle biopsy of that lesion, confirming whether it is exact nature.

If you want, I can tell you in detail about further treatment options or course of action if it turns cancerous. But at this point, I think this discussion would be premature.

As mentioned in your query, your maternal grandmother had Ca (cancerous) breast. Do you have any details about her cancer, like at what age she developed cancer? Also, what was the type of her cancer (hormone-positive or triple-negative)? And genetic testing done?

(These are just additional questions to see if there is a possibility of hereditary cancer)

I would be happy to help you further if you have any other questions. I hope this was helpful.

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