A 58-year-old woman has a screening mammogram showing new architectural distortion in the upper outer quadrant of the left breast, with no associated mass or calcifications. No prior surgery or trauma to that site is reported. What is the most appropriate next step?

• A Routine follow-up in 12 months
• B Targeted ultrasound of the area
• C Breast MRI
• D Stereotactic core needle biopsy ✓

Explanation

Architectural distortion without a history of surgery or trauma is suspicious for malignancy, particularly invasive lobular carcinoma or radial scar. The positive predictive value of architectural distortion for malignancy is approximately 50%. Stereotactic core needle biopsy is the standard tissue sampling method for architectural distortion, as it may not be visible on ultrasound. MRI is not the first-line intervention for a mammographic finding requiring tissue diagnosis.

Reference: ACR BI-RADS Atlas, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.