To compare the diagnostic value of full-field digital mammography (FFDM), automated breast ultrasound (AB US), and contrast-enhanced magnetic resonance imaging (MRI) in breast lesions with architectural distortion (AD).

A retrospective analysis was performed on the clinical, imaging, and pathological data of 171 lesions diagnosed as having AD on FFDM from January 2015 to December 2019, including 171 patients who underwent AB US examination and 108 patients who underwent contrast-enhanced MRI examination. Surgical or puncture pathological results were used as the gold standard for the diagnosis of the nature (benign or malignant) of the lesions; lesions without pathological results were interpreted as benign when there were no changes in imaging features after ≥2 years of follow-up. The diagnostic efficacy of FFDM, AB US, and contrast-enhanced MRI was calculated. Meanwhile, the retraction phenomenon on the coronal plane of AB US was analyzed.

A total of 171 cases were enrolled, of which 143 had pathological results, including 81 malignant and 62 benign lesions. The remaining 28 cases were proved to be benign by follow-up. The proportion of malignant cases with the retraction phenomenon on the coronal plane of AB US was 80.2% (65/81), which was significantly higher than that [45.6% (41/90)] in benign cases (P<0.001). The differences in specificity among FFDM, AB US, contrast-enhanced MRI, and FFDM combined with AB US (17.78% vs 37.77% vs 49.06% vs 47.78%) were statistically significant (P<0.05), but the sensitivity, accuracy, positive predictive value, and negative predictive value had no significant difference (P>0.05).

AB US combined with FFDM could improve the diagnostic efficacy for breast lesions with AD on FFDM. Negative breast MRI findings in such patients may have help avoid unnecessary interventions.