Anyone familiar with Dr. love's Breast Book or this Dr.?

Concerned2018

I just bought this book which is 690 pages and while I haven't read it all yet, the index doesn't show one sentence about architectural distortion and breast cancer, and I wonder if anyone knows why that is?

The reason I had a biopsy was because of architectural distortion which my reading online does not sound promising in terms of a benign outcome which scares the heck out of me, so I bought this book which was supposed to be the Breast Bible and I got the latest sixth addition, was surprised that the index the list architectural distortion. Can anyone comment on this!

Chevyboy

Hey Concerned!  This gives a pretty good explanation....  In other words, your team is checking everything out!  That's good..........

Pathology

Architectural distortion per se is not a mass. It is often due to a desmoplastic reaction in which there is focal disruption of the normal breast tissue pattern.

There are several features that can be considered as part of architectural distortion ³:

• contour abnormality
• trabecular thickening
• trabecular disorganisation

Aetiology

Many entities can cause architectural distortion ^1,4.In practice, the most common are surgery and potentially malignant breast lesions. Very subtle lesions are sometimes a feature in lobular breast carcinoma, which does not necessarily present with the features usually associated with infiltrating ductal carcinoma (IDC).

• primary causes
  • invasive breast cancer
    
  • ductal carcinoma in situ
  • 
    radial scar / complex sclerosing lesion
    
  • fat necrosis
  • sclerosing adenosis
• secondary causes 
  • previous breast surgery: post surgical breast scars (most common)
  • trauma
  • infection

Radiographic features

In most patients, there is global symmetry between the two breasts as far as the parenchyma is distributed and imaged. By comparing MLO and CC views carefully, subtle areas of asymmetry can be found that are sometimes not seen on quick look by neophyte observers. Parenchymal asymmetry is a routinely assessed feature in mammography and usually means any undue disruption in the usual parenchymal pattern.

It is considered as the third most-common appearance of breast cancer ¹ and at times can be a subtle finding on mammography.

History and etymology

In times before screening mammography became universally accepted, the diagnosis and surgery for breast pathology was a haphazard process at best. The diagnosis of carcinoma was invariably made once a tumour was clinically palpable to the clinician. Surgery was generally performed without preoperative imaging. The result was that women with benign breast changes would potentially end up with multiple surgeries to both breasts over the course of their lifetime. After mammography was implemented, it was often impossible to distinguish a postsurgical scar from the architectural distortion caused by the scirrhous reaction of a breast cancer. This is the reason why percutaneous needle biopsies are preferred in the eyes of the breast imager and why the demise of the blind open surgical biopsy was a happy day in the eyes of the breast imager.

Concerned2018

thank you for the detailed reply. I started to google and I thought the I in IDC stood for invasive but you wrote a different wird - "infiltrating"? Are they the same thing? Now I'm very upset because my surgeon said one thing, but I just got the written report and it doesn't exactly say the same thing. They say I have a radial scar and Complex sclerosing legion (are they the same thing?) and I thought my surgeon said that it was benign but that surgery would still be needed to remove the radial scar as a small percent like around 10 percent (which is not small if you're among the 10 percent!) turn out to be malignant. So, first they told me it was benign but nowhere on the report does it say the word benign. It also mentions microcalcifications which is making me very anxious because I thought elsewhere on this site people commented that was a bad sign. :-((