Impact of Breast Density and Other Factors on Mammography Guided Vacuum Assisted Breast Biopsy Microcalcification Retrieval Rates

INTRODUCTION: Mammography guided vacuum-assisted biopsy (MG-VAB) is the preferred method for histological diagnosis of screening mammography detected microcalcifications, yet the influence of breast density as well as other patient and procedure-specific factors on retrieval remains underexplored. The purpose of this study is to assess the impact of patient and procedure-specific factors on MG-VAB microcalcification retrieval rates. METHODS: A retrospective cohort study of 803 consecutive MG-VAB procedures for breast calcifications performed between August 2017 and May 2023 in the BreastScreen ACT population was conducted. Patient data collected included age, breast density, compressed breast thickness, lesion quadrant, calcification size, nipple-to-lesion distance, biopsy approach, specimen radiography visibility as well as presence on pathology. Bayesian logistic regression with weakly informative priors was applied to estimate microcalcification retrieval rates (MRR) and 90% credible intervals. RESULTS: The overall median MRR was 98.27% (790/803). Retrieval remained high across age groups (96.4%-99.6%), breast density (95.1%-98.7%), lesion quadrants (96.8%-99.1%), biopsy approach (97.9%-98.6%). Continuous factors such as compressed breast thickness, calcification size and nipple-to-lesion distance demonstrated stable retrieval across ranges. CONCLUSION: MG-VAB achieves consistently high microcalcification retrieval rates across a range of patient and procedural factors, including breast density. These findings reinforce its role as the first line diagnostic method for screening detected microcalcifications.