Comparative diagnostic efficiency of ultrasonography-guided core needle biopsy versus stereotactic-guided vacuum-assisted biopsy in breast microcalcifications: Results from a single academic institution

Background: Image-guided biopsy is essential for evaluating suspicious breast microcalcifications detected on mammography. At our institution, both ultrasonography-guided core needle biopsy (US-CNB) and stereotactic-guided vacuum-assisted biopsy (S-VAB) are routinely used based on imaging visibility and lesion characteristics. Objective: To assess the diagnostic performance and workflow outcomes of US-CNB and S-VAB as utilized in routine clinical practice for evaluating mammographically detected microcalcifications without an associated mass. Materials and Methods: We retrospectively reviewed 200 patients who underwent US-CNB (n=100) or S-VAB (n=100) between January 2019 and December 2023 at our institution. Clinical, imaging, and histopathological data were collected. Outcomes included malignancy rate, DCIS underestimation, false-negative rate, microcalcification retrieval, and malignancy rate by BI-RADS category. Results: Both biopsy methods demonstrated good diagnostic performance. US-CNB showed a higher malignancy rate (77%) than S-VAB (34%) (p < 0.001), attributed to imaging-driven selection of higher-risk lesions. DCIS underestimation was 42% for US-CNB and 24% for S-VAB (p = 0.297). One false-negative occurred in the US-CNB group. Microcalcification retrieval was confirmed in 81% of evaluated US-CNB cases and 100% of S-VAB cases (p < 0.001). Conclusion: In our institutional workflow, both US-CNB and S-VAB are effective and complementary techniques. While malignancy rates differ due to imaging selection bias, diagnostic outcomes support the continued use of both methods as appropriate to lesion characteristics.