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Tomosynthesis-Guided Vacuum-Assisted Excision of B3 Breast Lesions: Reducing Overtreatment Without Compromising Safety

Year: 2026

Type: article

Abstract: Objective: Breast lesions of uncertain malignant potential (B3) pose a diagnostic and management challenge. Surgical excision (SE) has traditionally been the standard for definitive diagnosis, but it may represent overtreatment. Percutaneous vacuum-assisted excision (VAE) offers a minimally invasive alternative. This study aimed to evaluate the safety and efficacy of VAE compared with SE for the management of B3 breast lesions, with the aim of reducing overtreatment. Materials and Methods: This retrospective single-center study included 64 patients with histologically confirmed B3 lesions diagnosed by tomosynthesis-guided vacuum-assisted breast biopsy between January 2018 and January 2024. Patients were managed by SE, VAE, or imaging follow-up, based on multidisciplinary team recommendations. Imaging characteristics, histopathology, upgrade rates, and follow-up outcomes were analyzed. Results: = 0.036). One SE patient developed invasive carcinoma at 48 months; no malignant progression occurred after VAE. Conclusion: VAE is a safe, minimally invasive and effective alternative to SE for carefully selected B3 lesions, particularly those without atypia and with imaging-pathology concordance, potentially reducing overtreatment. Multidisciplinary evaluation remains essential.

Source: European Journal of Breast Health

DOI: 10.4274/ejbh.galenos.2026.2025-9-7