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 <Emphasis Type="BoldItalic">Question</Emphasis>What is the diagnostic performance of VABB vs CNB in assessing suspicious breast lesions, including those with and without calcifications? <Emphasis Type="BoldItalic">Findings</Emphasis>Meta-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. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis>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. Graphical Abstract

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

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2026年1月19日

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Nisha Sharma,
Sina Theis,
Tobias Vogelmann,
Ruud Pijnappel

摘要

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.

Graphical Abstract