Vacuum-assisted breast biopsy vs core needle biopsy: a systematic review and meta-analysis

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OBJECTIVES: Vacuum-assisted breast biopsy (VABB) and core needle biopsy (CNB) are percutaneous biopsy methods used for the assessment of suspicious breast lesions. This systematic review and meta-analysis focused on comparative diagnostic performance outcomes of lesions biopsied with VABB or CNB. MATERIALS AND METHODS: Studies comparing VABB to CNB were searched in PubMed and Cochrane Library. Pooled risk ratios (RR) with 95% CI using random-effects models were calculated for atypical ductal hyperplasia (ADH) and ductal carcinoma in situ (DCIS) underestimation rates, repeat biopsy rate, concordance rate, calcification retrieval rate, and false-negative rate. Sensitivity analyses were performed using the leave-one-out approach. Risk of bias (RoB) was assessed using the quality assessment of diagnostic accuracy studies (QUADAS)-2 tool. RESULTS: Sixty studies were included from 937 records identified. ADH (RR: 0.63, 95% CI: 0.55-0.72, 22 studies) and DCIS (0.47, 0.39-0.58, 27 studies) underestimation was significantly lower with VABB compared to CNB. The repeat biopsy rate was significantly lower with VABB than with CNB (0.78, 0.69-0.88, 9 studies). VABB increased the likelihood that the surgical histology will match the biopsy (1.07, 1.04-1.11, 12 studies). The calcification retrieval rate was estimated to be significantly higher when using VABB (1.09, 1.04-1.14, 11 studies). Two-thirds of all studies had a low RoB. CONCLUSION: VABB, as a first-line diagnostic procedure, is superior to CNB in terms of delivering a definitive diagnosis and reducing upgrade rates to malignancy, delivering a safe and efficient patient workflow. KEY POINTS: QuestionWhat is the diagnostic performance of VABB vs CNB in assessing suspicious breast lesions, including those with and without calcifications? FindingsMeta-analysis results showed a significantly lower risk for DCIS underestimation, ADH underestimation, and repeat biopsies using any imaging-guided VABB compared to imaging-guided CNB. Clinical relevanceVABB, as a first-line diagnostic procedure, is superior to CNB in terms of delivering a definitive diagnosis and reducing upgrade rates to malignancy, delivering a safe and efficient patient workflow.

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