Abstract

Background: Breast cancer is the leading cause of cancer-related mortality among women worldwide. Among its imaging features, architectural distortion (AD) is common yet difficult to detect and easily overlooked, particularly on conventional 2D mammography. Digital Breast Tomosynthesis (DBT), or 3D mammography, has been shown to improve diagnostic accuracy for detecting such lesions, especially in dense breast tissue.

Methods: A cross-sectional descriptive study was conducted at Tam Anh General Hospital from June 2023 to June 2025. Female patients with suspected architectural distortion on mammography were enrolled. All participants underwent both 2D and 3D mammography, with lesion classification based on BI-RADS and histopathological correlation. Diagnostic indices assessed included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve (AUC).

Results: A total of 107 architectural distortion lesions were evaluated, including 45 cases of breast cancer (BC) and 62 benign cases. Lesions with high-density cores and associated microcalcifications were significantly more frequent in the malignant group (51.1% and 42.2%, respectively). Compared to 2D mammography, DBT showed higher sensitivity for detecting breast cancer (51.1% vs. 28.9%), especially in women with dense breasts, who comprised the majority of the study population. DBT identified 19 additional BC cases missed by 2D mammography (p < 0.001). While 2D mammography had higher specificity and PPV, it was more likely to miss lesions in dense tissue. DBT also showed superior risk stratification through BI-RADS scoring, with a higher AUC (0.675 vs. 0.636).

Conclusion: Digital Breast Tomosynthesis is a valuable imaging modality for diagnosing architectural distortion, particularly in the context of early breast cancer detection among women with dense breasts. Its broader application in Vietnam may enhance diagnostic accuracy and improve breast cancer outcomes.