Comparison of two visual localization biopsy methods for suspicious breast lesions under mammography: a multicenter cohort study.

Abstract

Background: Compared with traditional mammography, digital breast tomosynthesis (DBT) increases the detection of breast lesions by reducing the overlapping masking effect of glands through multi-angle exposures of a rotating X-ray tube. Breast biopsy under the guidance of mammography can effectively diagnose breast lesions. The main methods of mammography-guided biopsy include wire positioning, core needle biopsy (CNB), and vacuum-assisted breast biopsy (VABB). Currently, it is mainly guided by stereotactic or DBT-guided localization. In this study, we conducted a retrospective study to compare the clinical efficiency and performance of DBT-guided and prone stereotactic (PS)-guided breast lesion biopsies.

Methods: We performed a retrospective analysis of 406 patients who underwent mammogram-guided biopsies from three hospitals between August 2020 and August 2024. The cohort comprised 234 cases of DBT-guided biopsies and 172 cases of PS-guided biopsies. The DBT-guided biopsy methods included wire positioning, CNB, and VABB. The PS-guided biopsy methods included wire positioning and CNB. Statistical analyses utilized the Chi-squared or Mann-Whitney U tests to compare the effectiveness of biopsy methods acquired under DBT guidance and PS guidance.

Results: In wire positioning and CNB, both the DBT-guided group and PS-guided group had higher biopsy success rates (100% vs. 92.6%, 100% vs. 96.2%), with no statistically significant difference (P=0.154 and P=0.127, respectively). Compared to the PS-guided group, the DBT-guided group had shorter total intervention (P<0.001) and lesion targeting time (P<0.001), less time to obtain the first effective positioning images (P<0.001), and fewer exposure times (P<0.001). The incidence of complications was lower in both DBT-guided and PS-guided groups, with no statistically significant difference (P=0.851 and 0.861, respectively). In addition, we successfully performed 69 cases of DBT-guided VABB. Compared with wire positioning and CNB under DBT guidance, this method also had shorter total intervention (19.49±4.75 minutes) and lesion targeting time (5.00, 7.00 minutes), and reduced exposure time (4.00, 5.00 exposures).

Conclusions: DBT-guided biopsies outperformed PS-guided biopsies in clinical efficiency, achieving quicker procedures and requiring fewer exposures while enabling the biopsy of a broader range of non-calcified breast lesions.