Vacuum-Assisted Breast Biopsy and Excision for Breast Lesions: A Systematic Review and Meta-analysis of Malignant Upgrade in B3 Lesions.
Xuejing Wang
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In 30 seconds
This systematic review and meta-analysis examined malignant upgrade in B3 breast lesions assessed through diagnostic vacuum-assisted biopsy (VAB/VABB) or second-line vacuum-assisted excision (VAE). Five full-text studies contributed 844 lesions after diagnostic VAB/VABB, with 98 malignant upgrades; the pooled proportion was 11.23% (95% confidence interval [CI], 7.22%-17.04%; 95% prediction interval [PI], 4.56%-25.06%; I 2 = 60.8%). VAE findings were reported separately because study populations and selection pathways differed. The authors judged certainty in the principal observational outcomes very low.
Key findings
- After diagnostic VAB/VABB, 98 of 844 B3 lesions were upgraded to malignancy; pooled proportion 11.23% (95% CI, 7.22%-17.04%; 95% PI, 4.56%-25.06%; I 2 = 60.8%).
- Across three second-line VAE studies, study-specific malignant upgrade proportions ranged from 5.1% to 21.4%; estimates were not pooled.
- Post-VAE radiologic removal, absence of residual lesion, and recurrence-free outcomes ranged from 86.0% to 99.2% across five cohorts, but represented different endpoints and follow-up intervals.
Why it matters
The findings show that malignant upgrade estimates depend on whether vacuum-assisted procedures are used for diagnostic sampling or subsequent excision. Keeping these pathways distinct helps avoid misleading comparisons and supports interpretation of B3 lesion outcomes in context. The substantial variation and low certainty mean the pooled estimate should inform, rather than determine, clinical assessment.
What to keep in mind
Only five studies contributed to the pooled VAB/VABB estimate, with moderate heterogeneity. VAE outcomes were not pooled because of differing selection pathways, case mix, endpoints, and follow-up. Only one fully retrieved study provided reconstructable diagnostic accuracy data; certainty was very low for principal observational outcomes.