When architectural distortion is suspected, which evaluations are appropriate?

• A. Magnification views, targeted ultrasound, and MRI
• B. Repeat mammogram only
• C. Immediate surgical excision
• D. Palpation alone

Answer: (A)

Architectural distortion requires a multimodal imaging approach to accurately characterize it and guide biopsy. Magnification views enhance fine architectural detail by reducing tissue overlap, making distortion and any associated microcalcifications more conspicuous. Targeted ultrasound complements mammography by evaluating the distorted area for a corresponding mass, assessing internal features, and helping determine if a biopsy is needed. MRI adds sensitivity for detecting occult disease and outlining the extent of involvement, identifying additional foci or multifocal disease that other modalities might miss. Together, these evaluations provide a more complete assessment than repeating the mammogram, immediate surgical excision, or palpation alone, which may miss important findings or underestimate disease extent.