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

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.

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.

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.

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.

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.