MRI-Guided Vacuum-Assisted Breast Biopsy for MRI-Only Breast Lesions: Diagnostic Performance and Predictors of Histopathological Discordances.

RATIONALE AND OBJECTIVES: To evaluate the diagnostic performance of magnetic resonance imaging (MRI)-guided vacuum-assisted breast biopsy (MRI-VABB) for breast lesions detected only on MRI versus surgery and follow-up and to identify factors associated with histopathological underestimations and false negatives (FN). MATERIALS AND METHODS: In this retrospective single-center study, 292 breast lesions in 292 patients who underwent MRI-VABB between June 2015 and December 2024 were analyzed. Clinical, imaging, procedural, and histopathological data were collected to identify histopathological underestimations and FN. RESULTS: Among 292 lesions that underwent MRI-VABB, the overall malignancy rate was 28.4%. Histopathological discordance was observed in 6.5% (19/292) of lesions, including overall underestimation in 4.4% (13/292) and false negatives in 2% (6/292). Of the 6 false-negative cases, 2 were identified at immediate radiologic-pathologic concordance assessment and 4 during post-biopsy MRI follow-up at 7, 21, 35, and 36 months. On multivariable analysis, lesion location outside the outer quadrants was significantly associated with discordance (OR = 3.02; 95% CI, 1.09-9.79; p = 0.044). Lesion size ≥2 cm showed a nonsignificant trend toward higher odds of discordance (OR = 2.65; 95% CI, 0.96-7.01; p = 0.053). CONCLUSIONS: MRI-VABB is a reliable technique for evaluating breast lesions detected only on MRI. However, histopathological underestimation and false positives may still occur, particularly in lesions located outside the outer quadrants. Careful radiologic-pathologic concordance assessment and appropriate follow-up after benign biopsy results are essential to optimize patient management.