To compare the comprehensive efficacy of vacuum-assisted breast biopsy (VABB) and core needle biopsy (CNB) in the diagnostic evaluation of breast cancer.

A retrospective multicenter design was adopted. Clinical data of 241 breast cancer patients admitted to the First People's Hospital of Aksu Prefecture and Zhejiang Cancer Hospital from January 2023 to August 2024 were enrolled. According to the preoperative biopsy method, patients were divided into VABB group (n=119) and CNB group (n=122). Taking the postoperative pathological examination results as the gold standard, the Kappa test was used to compare the consistency of the two methods with the pathological diagnosis. Receiver operating characteristic (ROC) curve analysis and the Delong test were employed to evaluate the difference in diagnostic performance between the two methods. Continuous data with normal distribution were compared by independent sample t test;unpaired categorical data were compared by χ² test or Fisher's exact test;paired categorical data were compared by McNemar test.

No significant statistical differences were found between the diagnostic outcomes of VABB/CNB and pathological results (gold standard) for triple negative subtype (VABB: P=0.754; CNB: P=0.804). The corresponding Kappa values were 0.711 and 0.674 (both P<0.001), demonstrating good consistency with pathological diagnosis. For HER-2-positive subtype , no statistically significant differences were observed as well (VABB: P=0.774; CNB: P=0.424). The Kappa values were 0.749 and 0.698 (both P<0.001), reflecting favorable consistency. Statistically significant differences existed in Luminal A and Luminal B subtypes between the diagnostic outcomes of VABB/CNB and pathological results (both P<0.05). The Kappa values of VABB were 0.232 and 0.162, while those of CNB were 0.425 and 0.374, presenting poor consistency. In the four molecular subtypes of breast cancer, there was no statistically significant difference in AUC between CNB and VABB (Delong test, all P>0.05) . The AUC values for Luminal B and triple negative subtypes were relatively high (Luminal B: CNB group AUC=0.836, VABB group AUC=0.882; triple negative: CNB group AUC=0.831, VABB group AUC=0.843), indicating good diagnostic value. The AUC values for HER-2 positive and Luminal A subtypes suggested limited diagnostic accuracy (HER-2 positive: CNB group AUC=0.684, VABB group AUC=0.604; Luminal A: CNB group AUC=0.757, VABB group AUC=0.624) . Sample integrity in the VABB group was consistently good. The sample volume in the VABB group was significantly larger than that in the CNB group [(1.04±0.30) cm³vs (0.10±0.02) cm³, t=-34.532, P<0.001]. The biopsy success rate of 100% and no repeated biopsies. The positive detection rate of tumor spatial heterogeneity in the VABB group was higher than that in the CNB group (30.3% vs 18.9%, χ²=4.234, P=0.040). Intraoperative blood loss in the VABB group was significantly higher than that in the CNB group [(2.24±0.72) ml vs (1.84±0.89) ml, t=-3.749, P<0.001] , but the incidence of postoperative hematoma was lower (0.8% vs 9.9%, χ²=9.553, P=0.002) , and the patient satisfaction score was higher (8.59±0.56 vs 6.16±0.80, t=–27.352, P<0.001) .

VABB is superior to CNB in obtaining high-quality tissue samples, improving the positive detection rate of tumor spatial heterogeneity and patient satisfaction, with good overall safety.