Vacuum-assisted breast biopsy: more cores, more hematomas?

Vacuum-assisted breast biopsy (VABB) is used for the diagnosis of non-palpable breast lesions. Hematoma has been recognized as the main complication of the procedure. Its main disadvantage is the underestimation rate. Generally speaking, approximately up to 24 cores are excised in most published series. It has been suggested that excision of more cores per lesion can reduce the underestimation rate. The present study aims to evaluate hematoma formation with regard to the number of cores excised.

A total of 660 women underwent VABB; 232 women were allocated to the standard protocol (24-36 cores excised, 2-3 offsets) and 428 women were allocated to the extended protocol (96 cores excised, 8 offsets). Cases were derived from a double blind study, as well as from the periods before (standard protocol) and after (mainly extended protocol) the study. In all cases, the occurrence of organized hematomas within the subsequent 20 days was followed up by ultrasound.

In the standard protocol, the frequency of clinically significant and subsequently organized hematomas was 3.5%. However, in the extended protocol the respective hematoma percentage was 7.5%. Clinically significant and subsequently organized hematomas were significantly more frequent in the extended protocol (Pearson's chi-squared=4.29, p=0.038).

Despite the superiority of the extended protocol in terms of underestimation, the approximately two-fold increase in hematoma occurrence prompts the need for careful patient selection prior to its performance.