Ultrasound-guided vacuum-assisted excision: A minimally invasive solution for managing imaging-histological discordant breast lesions after core needle biopsy.

OBJECTIVE: To evaluate the role of US-guided Vacuum-assisted excision (VAE) in the management of imaging-histological discordant lesions after core needle biopsy (CNB), avoiding unnecessary surgical excision. MATERIALS AND METHODS: We retrospectively evaluated all patients who underwent US-guided VAE with a 9 G needle between January 2015 and August 2023 for imaging-histological discordance after CNB. We determined the upgrade rate to malignancy (UR) after VAE and delayed false-negative results after surgery or follow-up. We assessed the diagnostic performance of the procedure, technical efficacy (TE), technical success (TS), the occurrence of complications and the correlation between upgrade to malignancy and lesion size, BI-RADS category, morphological characteristics, presence of calcifications and history of breast cancer (χ2 and Mann-Whitney tests). RESULTS: We collected data from 334 patients (median age 47.5 years, IQR 14). After VAE, 70.6 % (N = 236) of the excised lesions were benign, 20.1 % (N = 67) were B3 lesions and 9.3 % (N = 31) were malignant. The UR to malignancy was 9.3 %. The delayed false negative results were 1.3 %. Accuracy was 98.2 % [95 % CI: 0.95-0.99], SE was 88.6 % [95 % CI: 0.73-0.97], SP was 100 % [95 % CI: 0.98-1], PPV was 100 % [95 % CI: 0.89-1] and NPV was 97.9 % [95 % CI: 0.95-0.99]. TE was 84.4 %; TS was 100 %. No major complications were observed. BIRADS category, morphology, margins, and orientation of the lesion were significantly associated with upgrade to malignancy (p < 0.001). CONCLUSIONS: VAE reduces the risk of underestimation of associated malignancy in imaging-histological discordant lesions and increases diagnostic accuracy, thus reducing the need for surgery, without compromising the quality of patient care.