Diagnostic Value Of Vacuum-Assisted Breast Biopsy For Breast Carcinoma: A Systematic Review

Objective:To evaluate the quality of the current studies involving the value of VAB in the diagnosis of breast cancer; to establish the overall value of VAB for the diagnosis of breast cancer and assess the underestimation rate of ADH and DCIS.Method:We comprehensive collected current studies about VAB by computer and manual searches QUADAS items were used for quality assessment in our systematic review. Meta-disc and STATA software were used to analyze sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio, diagnostic test odds ratio for the pooled analysis and heterogeneity test, and draw SROC curves.Result:Totally 21 studies were included,3 Chinese studies and 18 English studies.21 studies had better control the bias from spectrum composition, selection criteria, reference standard, differential verification, incorporation bias, index test execution, test review bias and clinical review bias. The disease progression bias, partial verification and reference standard review bias may occur. There were not about reporting uninterpretable test results and withdrawals.The summary estimates for VAB in diagnosis of breast carcinoma were as follows:sensitivity,0.981 (95% confidence interval [CI],0.972 to 0.987); specificity,0.999 (95% CI,0.997 to 0.999); positive likelihood ratio,93.84 (95% CI,41.55 to 211.95); negative likelihood ratio,0.05 (95% CI,0.03 to 0.09); diagnostic odds ratio,1891.7 (95% CI,683.8 to 5233.4), underestimate rate of ADH and DCIS were 20.9%(95% CI,0.177 to 0.245) and 11.2%(95% CI, 0.098 to 0.128) respectively.Conclusion:Therefore, the bias was mainly disease progression bias and partial verification in the 21 studies. Reporting uninterpretable test results was worried. The studies presented the large variation. Variations were mainly from the choice of the objects of disease, medical environment et al.VAB is a highly sensitive and specific biopsy method for evaluating mammographically detected breast women. To be on the safe side, the diagnosis of ADH in VAB warrants surgical excision.