Vacuum-Assisted Excision of Breast Lesions: An Analysis of Costs in the Private Healthcare Sector

Vacuum-Assisted Excision of Breast Lesions: An Analysis of Costs in the Private Healthcare Sector | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Vacuum-Assisted Excision of Breast Lesions: An Analysis of Costs in the Private Healthcare Sector Samirah Luiza Barbosa Santos, Sarah Costa Prates, Victor Eduardo Mendes, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8312678/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Overdiagnosis and overtreatment have become central issues in the current debate on breast cancer screening and management. Breast cancer remains the most prevalent malignancy among women worldwide, imposing a substantial clinical and economic burden. In this context, vacuum-assisted excision (VAE) has emerged as an effective diagnostic and therapeutic alternative for suspicious breast lesions, offering lower morbidity and potential cost reduction compared with conventional surgery. In Brazil, particularly within the private healthcare sector, national evidence evaluating the direct economic impact of VAE remains scarce. Therefore, this study aimed to analyze the direct costs associated with the use of VAE in the management of suspicious breast lesions in the private healthcare sector. Methods A retrospective cohort study was conducted including women with BI-RADS™ 4 or 5 lesions who were submitted to VAE between 2022 and 2024. A total of 149 patients with complete clinical and pathological data were analyzed. The analysis included medical fees, diagnostic tests, surgical procedures, and costs of special materials. Clinical, radiological, and histopathological variables were evaluated. Results Age, radiological features, and lesion size did not significantly influence overall costs. Prior core needle biopsy and the need for surgery were the main determinants of increased expenses. In the cost-saving group (n = 97), 98.97% of cases were definitively managed with VAE alone, without the need for surgery. In the non–cost-saving group (n = 52), 36.54% of patients underwent surgery. Median total cost in the cost-saving group was USD 1,053.67, while in the non–cost-saving group it reached up to USD 3,140.62. Discussion Vacuum-assisted excision proved to be a highly resolutive, safe, and economically advantageous strategy for the management of suspicious breast lesions in the private healthcare setting. The absence of additional procedures - especially prior core needle biopsy and surgery - was the main factor associated with cost savings. These findings reinforce the role of VAE in reducing surgical overtreatment, optimizing resource allocation, and modernizing breast care delivery. Our results support the systematic incorporation of VAE into clinical protocols within private healthcare, benefiting both patients and healthcare providers. Vacuum-assisted excision Cost-analyses Minimally invasive procedures Breast surgical overtreatment Figures Figure 1 Figure 2 Introduction Breast cancer is the leading malignancy affecting women worldwide and represents an expanding public health challenge, given the continuous rise in incidence, prevalence, and mortality projected for the coming years 1 , 2 . This scenario places additional pressure on health care systems, intensifying the demand for diagnostic methods that offer accuracy, safety, reduced morbidity, and favorable cost-effectiveness to ensure timely diagnosis and improve clinical outcomes 3 . Vacuum-assisted excision (VAE) has emerged as a minimally invasive technique capable of providing both diagnostic accuracy and therapeutic excision for a wide spectrum of breast lesions 4 . As a percutaneous procedure performed under image guidance and local anesthesia, VAE removes large volumes of tissue through a vacuum-powered needle, allowing complete removal of small to medium breast lesions while minimizing morbidity. Evidence indicates that VAE offers major advantages when compared with conventional surgical excision, especially for benign lesions and lesions of uncertain malignant potential 5 . Of note, a recent systematic review with meta-analysis of our research group reported no significant difference in local recurrence between VAE and surgical excision for benign phyllodes tumors, reinforcing the procedure safety 6 . Concerning imaging features, VAE is the preferred technique for small lesions, architectural distortions, calcifications, small intraductal masses, and lesions visible only through mammography or magnetic resonance imaging 7 . Because VAE is performed in an outpatient setting and avoids general anesthesia and hospitalization, it substantially reduces direct and indirect costs. Previous studies indicate that recovery is faster and complication rates are lower than with surgical lumpectomy, and in private health systems or regions with limited resources, VAE may improve accessibility and reduce the burden on surgical services and economic analyses highlight its potential to decrease healthcare expenditure by reducing the need for operating room time and repeated surgeries 8 . In the context of the Brazilian supplementary healthcare sector - characterized by progressively rising surgical costs and the urgent need to optimize resource allocation - there has been a growing adoption of vacuum-assisted excision (VAE). Although the technique has proven to be a highly valuable diagnostic and therapeutic tool in breast disease management, national literature still lacks studies evaluating its direct costs or comparing the economic performance of VAE with that of conventional surgical excision 9 . Given this scenario, the present study aims to analyze the direct costs associated with VAE within the private healthcare sector, exploring its economic implications for supplementary health systems. By doing so, this investigation seeks to provide evidence that supports protocol standardization, enhances patient experience, and optimizes resources allocation in the setting of increasing demand for diagnostic and therapeutic procedures related to breast cancer. Methods This retrospective transversal cohort study compared the direct costs of vacuum-assisted excision (VAE) and diagnostic lumpectomy for the evaluation of suspicious breast lesions. The study was approved by the UNIFIPMoc Research Ethics Committee under protocol number (CAAE) 88693025.3.0000.5109. Women presenting with ultrasound ACR BI-RADS™ categories 4 or 5 lesions and undergoing vacuum-assisted excision at a breast unit in Brazil between 2022 and 2024 were included. Data collection was performed through review of electronic medical records using a structured instrument developed by the research team. Patients presenting with lesions classified in categories other than BI-RADS™ 4 or 5, VAE procedures performed outside the specified period and incomplete or inconclusive records that prevented statistical analysis were not included. All histopathological and immunohistochemical reports were reviewed. Direct costs of VAE and diagnostic lumpectomy were analyzed and compared based on values established by a specific private healthcare provider, which was used as a reference. The analysis included expenses related to specialist consultations (breast surgeon and anesthesiologist, if needed), breast imaging exams, diagnostic and preoperative tests, and the procedure itself, encompassing physician fees, hospital charges and special material costs. To separate the analyzed groups, we reviewed all imaging studies and asked a key question: “Considering the lesion’s imaging features and its pathology, did the patient management represented a potential reduction in healthcare expenditures?” (Fig. 1 ). Statistical Analysis Normality of continuous variables was assessed using the Shapiro–Wilk test, which demonstrated that all variables followed a non-parametric distribution. Therefore, continuous variables were summarized using medians and interquartile ranges (P25–P75), whereas categorical variables were presented as absolute (n) and relative (%) frequencies. For comparative analyses, patients were stratified into the two groups according to the economic outcome of the study: (I) the group that achieved direct cost savings (n = 97) and (II) the group without direct cost savings (n = 52). Continuous variables were compared between groups using the Mann–Whitney test, while categorical variables were evaluated using Fisher’s Exact test or the Chi-square test. When more than 20% of expected frequencies fell below 5 occurrences, the Chi-square test with Monte Carlo simulation was applied to ensure greater robustness and precision of the estimates. All statistical analyses were performed using Stata® software (version 14.0, Stata Corporation, College Station, TX, USA). Differences were considered statistically significant when p-values were below 0.05 (p < 0.05). Results Of 265 medical records reviewed, 149 patients were included as these were the cases with accessible data and complete pathological assessment. These patients were evaluated to compare the direct costs of vacuum-assisted excision, with or without additional diagnostic or surgical procedures, in the management of suspicious breast lesions. Table 1 summarizes the clinical characteristics and initial diagnostic trajectory of the included patients. Table 1 Clinical and demographic characteristics of patients according to direct cost savings DIRECT COSTS SAVING p value Yes (n = 97) No (n = 52) n % n % Age (years) (n = 149) Median (P25 - P75) 48 (41–57) 51,5 (42–61,5) 0,287 MW Min - Max 28–84 26–89 Age group (n = 149) 20–40 years 19 19,59 11 21,15 0,086 Q 41–50 years 42 43,30 12 23,08 51–60 years 18 18,56 15 28,85 > 61 years 18 18,56 14 26,92 Residence in Montes Claros? (n = 149) Yes 65 67,01 37 71,15 0,604 Q No 32 32,99 15 28,85 VAE number of fragments (n = 149) Median (P25 - P75) 15 (12–24) 19 (12–24) 0,062 MW Min - Max 5–54 6–48 Prior Tru-Cut Biopsy? (n = 149) Yes 3 3,09 11 21,15 0,001 * F No 94 96,91 41 78,85 Underwent surgery? (n = 149) Yes 0 0,00 19 36,54 0,000 * F No 97 100,00 33 63,46 Complications (n = 75) No complications 30 58,82 11 45,83 0,292 Q Hematoma 21 41,18 13 54,17 n absolute frequency; % percentage; P25 25th percentile; P75 75th percentile; Min minimum value; Max maximum value. * Statistically significant difference (p < 0.05); F Fisher’s Exact test; MW Mann–Whitney test; Q Chi-square test In the comparison between patients who generated direct cost savings (n = 97) and those who did not (n = 52) the median age, age-group analysis, the municipality of residence and the number of tissue fragments obtained during VAE showed no association with the economic outcome (p > 0.05). Among all variables in Table 1 , only two were significantly associated with cost-savings. The first was prior core biopsy: the non-saving group had a substantially higher proportion of patients who had undergone a prior Tru-Cut biopsy (21.15% vs. 3.09%; p = 0.001). The second significant variable was whether the patient underwent surgery after the initial diagnosis: none of the patients in the cost-saving group underwent surgery, whereas 36.54% of the non-saving group did (p = 0.000). These findings highlight the direct impact of additional diagnostic and therapeutic procedures - particularly prior core biopsy and surgery - on total cost. Among the 75 patients with recorded complications, the rate of hematoma did not differ significantly between groups (p > 0.05), suggesting that minor adverse events did not affect cost outcomes. Overall, results indicate that the absence of additional procedures - especially the lack of prior core biopsy and the avoidance of surgery - was the primary determinant of direct cost savings. These data reinforce that, in clinical practice, diagnostic strategies that are resolutive and minimize the need for complementary procedures tend to reduce costs and optimize the management of suspicious breast lesions. Table 2 presents the radiological and histopathological characteristics of the breast lesions evaluated in the 149 patients included in the study, compared to the presence or absence of direct cost savings. The aim of this analysis was to determine whether factors related to lesion type, imaging size, or histopathological diagnosis influenced the economic outcome. According to the findings from the lesion-type analysis, the distribution was similar between the groups (p > 0.05). Nodular lesions represented the majority of cases in both groups − 63.92% among patients who generated savings and 61.54% among those without savings. The assessment of lesion size on imaging also showed no significant difference between groups (p > 0.05), as the median measurements were nearly identical (10.5 mm in the savings group vs. 10 mm in the non-savings group), suggesting that, in this study, lesion size did not impact cost outcomes. Table 2 Radiological and histopathological characteristics of breast lesions according to the presence of direct cost savings. DIRECT COST SAVINGS p value Yes (n = 97) No (n = 52) n % n % Lesion type (n = 149) Nodule 62 63,92 32 61,54 0,339 Q Non-nodular lesions 21 21,65 8 15,38 Other 14 14,43 12 23,08 Lesion size on imaging (mm) (n = 145) Median (P25 - P75) 10,5 (8–15) 10 (8–14) 0,680 MW Min - Max 3,3–40 3,9–41 Histopathology VAE (n = 149) Malignant lesions(IDC, DCIS) 0 0,00 11 21,15 0,000 * Q B3 lesions (uncertain malignant potential) 64 65,98 15 28,85 Benign lesions 33 34,02 26 50,00 n absolute frequency; % percentage; P25 25th percentile; P75 75th percentile; Min minimum value; Max maximum value. * Statistically significant difference (p < 0.05); F Fisher’s Exact test; MW Mann–Whitney test; Q Chi-square test In contrast, a statistically significant difference was observed in the histopathological results obtained through VAE (p = 0.000): among patients without cost savings, 21.15% presented malignant lesions (IDC or DCIS), whereas none of the patients in the savings group had a malignant diagnosis on VAE (0.00%) (Fig. 2 ). Additionally, benign lesions were more prevalent in the non-savings group (50.00%) compared with the savings group (34.02%), reflecting a greater proportion of fibroadenomas, adenomas or proliferative lesions without atypia among patients who did not generate cost savings (Table 2 ). This finding, together with the higher rate of surgeries observed in Table 1 , suggests that some of these patients may have undergone potentially unnecessary surgical procedures, considering that such lesions could have been managed less invasively through VAE. Finally, the cost-saving group showed a predominance of B3 lesions (65.98%), which contrasts markedly with the non-saving group (28.85%). The findings presented in Table 2 suggest that the biological behavior of these lesions - rather than its initial radiological appearance - was the main determinant of final cost in the management of suspicious breast lesions in this study. Table 3 provides a direct comparison of the costs associated with the different diagnostic and therapeutic procedures performed in the 149 patients included in the study, according to whether direct cost savings were achieved. Regarding vacuum-assisted excision (VAE), all patients in both groups underwent the procedure (100.00%), as VAE constituted the initial diagnostic method employed. The approximate cost of VAE was USD $ 1053.67. In the analysis of Tru-Cut core biopsy, a significant difference was observed between groups (p = 0.001): only 3.09% (3/97) of patients who achieved savings required a prior core biopsy, whereas 21.15% (11/52) of those without savings underwent this procedure (Fig. 4). This finding indicates that additional diagnostic tests substantially increased costs in the non-saving group (Table 3 ). Table 3 Economic analysis of procedures according to direct cost savings DIRECT COST SAVINGS p value Yes (n = 97) No (n = 52) Procedure / Cost (USD $ ) Vacuum Assisted (n = 149) Number of patients, n (%) 97 (100,00) 52 (100,00) --- Cost (USD$) 1053.67 1053.67 Tru-Cut Core biopsy (n = 14) Number of patients, n (%) 3 (3,09) 11 (21,15) 0,001 * F Cost (USD$) 195.02 195.02 Surgery (USD$) (n = 19) Number of patients, n (%) 0 (100,00) 19 (36,54) 0,000 * F Cost (USD$) --- 1891.93 Valor total (R$) (n = 149) Median (P25 - P75) 1053.67 (1053.67–1053.67) 1248.69 (1053.67–2954.60) 0,000 * MW Min - Max 1053.67–1248.69 1053.67–3140.62 Notes: F = Fisher’s Exact test; MW = Mann–Whitney test. * Statistically significant (p < 0.05). Estimated costs based on a private health provider operating in northern Minas Gerais. 1 US Dolar = 5,33 BR Real on November 20, 2025. Even more pronounced differences were observed in the variable “Surgery” (p = 0.000): 36.54% (19/52) of patients in the non-saving group underwent surgery, with an approximate cost of USD $ 1891.93, while no patient in the savings group required this intervention. This discrepancy directly influenced the final treatment cost and demonstrates that the need for surgery was the primary determinant of the absence of savings (Table 3 ). To identify the clinical profiles most associated with direct cost savings, we analyzed patients according to the distribution of five clinical-economic groups defined by surgical indication, need for core biopsy, and the resolutive capacity of VAE. According to the data presented in Table 4 , there was a statistically significant difference between groups (p = 0.000), indicating that the diagnostic and therapeutic pathway taken by each patient directly impacted the final cost. Malignant lesions, which necessarily require surgical treatment, were obviously observed exclusively in the non-saving group (21.15%; 11/52). Likewise, patients who underwent prior core biopsy -which represents an additional expense - were also concentrated in the non-saving group (19.23%; 10/52). Table 4 Distribution of patients across the five clinical–economic groups according to the presence of direct cost savings. DIRECT COST SAVINGS p valor Yes (n = 97) No (n = 52) n % n % Clinical Groups (n = 149) Malignant lesions (require surgery) 0 0,00 11 21,15 0,000 * Q Patients who underwent a prior Tru-Cut biopsy (an unnecessary expense) 0 0,00 10 19,23 Patients for whom the core biopsy alone would have been sufficient 1 1,03 23 44,23 Patients in whom vacuum procedure was definitive 96 98,97 0 0,00 Patients who underwent surgery despite a benign VAE result 0 0,00 8 15,38 n absolute frequency; % percentage. * Significant difference (p < 0.05); Q Chi-square test with Monte Carlo simulation. Patients for whom core biopsy alone would have been sufficient formed the majority of the non-saving group (44.23%; 23/52), suggesting unnecessary duplication of diagnostic methods and representing a scenario where VAE was an excess. In contrast, almost all patients in the cost-saving group belonged to the category in which VAE was fully resolutive (98.97%; 96/97), demonstrating the efficiency of VAE as a single-step approach. Furthermore, cases in which surgery was performed despite a benign VAE result occurred only in the non-saving group (15.38%; 8/52), reinforcing the possibility of excessive intervention (Table 4 ). Overall, Table 4 shows that direct cost savings were strongly associated with the resolutive nature of VAE and the absence of additional procedures - especially Tru-Cut biopsy and surgery. Conversely, patients who underwent duplicated diagnostic steps, unnecessary surgery, or who presented malignant lesions incurred higher costs. These findings underscore the importance of well-structured clinical protocols to avoid diagnostic redundancy and inappropriate surgeries, thereby optimizing costs and reducing morbidity in the management of suspicious breast lesions. Discussion Vacuum-assisted excision (VAE) has been consolidated as a highly effective minimally invasive technique for both the diagnosis and treatment of breast lesions, allowing the removal of substantial tissue volumes with high precision, diagnostic accuracy, and, frequently, definitive therapeutic intent 4 , 6 , 10 . In agreement with these findings, the present study demonstrated a VAE resoluteness rate of 98.97% in the cost-saving group, in which vacuum-assisted excision alone was sufficient as the only therapeutic approach, without the need for additional procedures. Our results clearly demonstrate the greater economic efficiency of VAE compared with surgical excision for the management of suspicious breast lesions. The cost-saving group presented a fixed mean cost of USD $ 1053.67, exclusively related to VAE procedure. In contrast, the non–cost-saving group showed costs ranging from 1248.66 to 3140,62 USD, driven by the need for additional procedures such as prior core needle biopsy and surgery. This difference is explained by the elimination, in resolutive VAE, of expenses related to hospitalization, anesthesia, surgical fees, preoperative examinations, and specialized materials. These findings are consistent with international studies demonstrating that VAE maintains high diagnostic accuracy while significantly reducing costs associated with unnecessary surgical procedures 11 , 12 , reinforcing its strategic value for the sustainability of private health care systems. Duplication of diagnostic methods played a central role in increasing costs in the non–cost-saving group. In this study, 21.15% of patients in this group underwent core needle biopsy before VAE, generating an additional mean increase of approximately USD $ 195.02 per patient. In well selected patients, the direct use of VAE not only provides higher diagnostic accuracy but also reduces false-negative rates and the final cost of treatment 13 . Evidence from systematic reviews, international guidelines, and ongoing clinical trials demonstrates that VAE achieves outcomes comparable to surgical excision for multiple lesion types, including benign phyllodes tumors and B3 lesions, while also offering advantages of reduced morbidity, superior cosmetic outcomes, and improved patient satisfaction 4 , 6 , 8 , 12 , 14 . In the present analysis, 65.98% of patients in the cost-saving group who presented B3 lesions on VAE pathology had definitive resolution with vacuum procedure alone. Conversely, in the non–cost-saving group, 28.85% of patients had B3 lesions, and a proportion of these women underwent surgery despite benign VAE findings, suggesting potential overtreatment. Thus, vacuum-assisted excision proves to be highly resolutive and particularly indicated for benign breast lesions, effectively avoiding unnecessary conventional surgical interventions in these cases. Histopathological diagnosis also had a direct impact on the economic and therapeutic profile. No patient in the cost-saving group presented malignancy, whereas 21.15% of patients in the non–cost-saving group were diagnosed with carcinoma (DCIS/IDC) and consequently required surgery. Notably, 15.38% of patients who underwent surgery in the non–cost-saving group were ultimately diagnosed with benign lesions, reinforcing the hypothesis of overtreatment. This pattern has been widely debated in the literature, which increasingly supports the adoption of VAE as definitive treatment for selected B3 lesions to reduce unnecessary surgeries 5 , 15 . From a radiological perspective, no significant association was observed between imaging characteristics and total treatment cost. The type of imaging-detected lesion, with a predominance of nodules in both groups, as well as the mean lesion size (10.5 mm in the cost-saving group and 10.0 mm in the non–cost-saving group), showed no statistically significant difference (p > 0.05). These findings indicate that cost savings are not primarily dependent on lesion appearance or size but rather on post-diagnostic clinical management, especially regarding the need for additional procedures. Moreover, adverse events were minimal and similarly distributed between groups, with no relevant impact on overall costs. Our data strongly supports VAE as a strategic tool for private health care systems, demonstrating that its availability can generate economic benefits for both patients and health insurance providers. When VAE is used as the initial resolutive approach, it can represent a significant reduction in healthcare expenditures while also providing an improved patient experience, as previously shown 16 , 17 . In this context, the high resoluteness rate of VAE (98.97%) directly contributes to reductions in hospital costs, admissions, and additional procedures. Therefore, the systematic incorporation of VAE aligns with international guidelines prioritizing dehospitalization, efficiency of care, and financial sustainability 12 , serving as a key instrument for modernizing the breast care model in private health systems. It is also noteworthy that our analysis did not encompass indirect costs associated with these procedures - such as recovery-related expenditures, complications, productivity losses - nor did it incorporate the perspectives of patients who underwent either vacuum-assisted excision or surgical excision. Finally, emerging studies, including the VAE-BREAST and SMALL trials, suggest that VAE may play a central future role in the therapeutic de-escalation of small, biologically favorable breast cancers 4 , 14 , 18 . In addition, national data report significant delays in the initiation of breast cancer treatment 19 , a scenario in which VAE may contribute to accelerating diagnostic confirmation and reducing intermediate steps that prolong the time to definitive treatment. Thus, VAE of breast lesions is consolidated not only as an effective diagnostic and therapeutic method but also as a strategic instrument to optimize resources, reduce overtreatment, and enhance the quality of care in health systems. Conclusion Vacuum-assisted excision (VAE) demonstrated in this study high clinical efficacy, excellent resoluteness and a clear economic advantage in the management of breast lesions. The use of VAE as the initial therapeutic strategy allowed definitive resolution of most cases, with a significant reduction in the need for additional diagnostic procedures, hospital admissions, and conventional surgeries, directly optimizing health care resources. The results confirm that the observed cost savings were not related to radiological lesion characteristics but rather to post-diagnostic clinical decision-making, particularly the rational use of sequential diagnostic and therapeutic methods. Therefore, the systematic incorporation of VAE into clinical protocols represents a safe, efficient, and economically sustainable strategy, with the potential to reduce overtreatment, improve the patient experience, and contribute to the modernization of breast health care. This study reinforces the need to expand the use of VAE in the private health care setting and encourages further national research to deepen the evaluation of its clinical, economic, and organizational impact. Declarations Competing Interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential competing interest. Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Centro Universitário UNIFIPMoc under the number (CAAE) 88693025.3.0000.5109. The study was conducted in accordance with local legislation and institutional requirements. Informed consent was not required since the study was structured as a retrospective analysis of medical records. Funding The authors declare no financial support was received for the research and/or publication of this article. Author Contribution All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Samirah Luiza Barbosa Santos, Sarah Costa Prates, Victor Eduardo Mendes, Henrique Lima Couto and Bertha Andrade Coelho. The first draft of the manuscript was written by Bertha Andrade Coelho and Henrique Lima Couto and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors thank Doctor Christine Mendes Silveira for reviewing the histopathological examinations and Bruna Torres Silvestre da Silva for specialized assistance with the statistical analysis. Data Availability The datasets generated during the current study arere not publicly available due to the presence of sensitive patient information but are available from the corresponding author on reasonable request. References Cai Y, Dai F, Ye Y et al (2025) The global burden of breast cancer among women of reproductive age: a comprehensive analysis. Sci Rep 15:9347. 10.1038/s41598-025-93883-9 Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7–33. 10.3322/caac.21654 Xiong X, Zheng LW, Ding Y et al (2025) Breast cancer: pathogenesis and treatments. Signal Transduct Target Ther 10(1):49. 10.1038/s41392-024-02108-4 Couto HL, Coelho BA, Ricardo BFP et al (2025) Vacuum-assisted excision: one-step approach to the diagnosis and percutaneous treatment of small early breast cancer (the VAE-BREAST 01 study protocol). Front Oncol 15:1687634. 10.3389/fonc.2025.1687634 Elfgen C, Leo C, Kubik-Huch RA et al (2023) Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Virchows Arch. ;483(1):5–20 Gil MLBV, Coelho BA, Couto HL et al (2024) Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment—a systematic review and meta-analysis. Front Oncol 14:1394116. 10.3389/fonc.2024.1394116 Sanderink WB, Camps-Herrero J, Athanasiou A et al (2025) Image-guided biopsy of breast lesions—when to use what biopsy technique. Insights Imaging 16(1):208 Morgan J, Potter S, Sharma N et al (2019) The SMALL trial: a big change for small breast cancers. Clin Oncol 31(9):659–663 Linhares LMAC, Avelar JTC, Alves GR et al (2025) Vacuum-assisted biopsy and excision of breast lesions: review and current indications. Mastology 35. 10.29289/259453942023047 American Society of Breast Surgeons. The Use of Transcutaneous and Percutaneous Ablation for the Treatment of Benign and Malignant Tumors of the Breast. Consensus Guideline (2025) Available from: https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-the-Use-of-Transcutaneous-and-Percutaneous-Methods-for-the-Treatment-of-Benign-and-Malignant-Tumors-of-the-Breast.pdf . Accessed November 28, 2025 Whitworth P, Hogan A, Ferko N et al (2020) Reduced hospital costs for ultrasound-guided vacuum-assisted excision compared with open surgery in patients with benign breast masses and high-risk lesions. J Breast Imaging 2(5):452–461. 10.1093/jbi/wbaa055 van de Voort EMF, Struik GM, van Streun SP et al (2022) Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum-assisted excision versus surgical excision. Br J Radiol 95(1136):20220117. 10.1259/bjr.20220117 Zhang Y, Li J, Mo M et al (2023) The comparison of efficacy and safety evaluation of vacuum-assisted Elite 10-G system and the traditional BARD 14-G core needle in breast diagnosis: an open-label, parallel, randomized controlled trial. Int J Surg 109(5):1180–1187. 10.1097/JS9.0000000000000257 Couto HL, Valadares CN, Soares AN et al (2025) Vacuum-assisted biopsy in the era of low-risk ductal carcinoma in situ active monitoring: real world data and implications. Front Oncol 15:1618476. 10.3389/fonc.2025.1618476 Pinder SE, Shaaban AM, Deb R et al (2018) NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 73(8):682e1–682e7 van de Voort EMF, Struik GM, van Streun SP et al (2020) Patient-reported cosmetic outcome after vacuum-assisted excision of benign breast lesions: a cross-sectional study. Br J Radiol 93(1114):20190994. 10.1259/bjr.20190994 Dong Y, Huang Y, Qiu L, Yang Y, Feng W, Shi XQ (2025) Predictive model for hematoma formation following ultrasound-guided excision of benign breast lesions. J Surg Res 305:275–285. 10.1016/j.jss.2024.11.047 Elder K, Coles C, Dodwell D et al (2025) SMALL: open surgery versus minimally invasive vacuum-assisted excision for small screen-detected breast cancer—protocol for a phase III randomised multicentre trial. BMJ Open 15(4):e099702. 10.1136/bmjopen-2025-099702 Figueiredo CL, Mendes PHC, Caldeira AP, Lucena CEM, Coelho BA (2025) Breast cancer treatment delay associated factors in Northern Minas Gerais. Cad Saúde Colet 33(1):e33010155. 10.1590/1414-462X202533010155 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8312678","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":557484372,"identity":"28ab80d9-d791-4c3e-8f64-6effe69c980e","order_by":0,"name":"Samirah Luiza Barbosa Santos","email":"","orcid":"","institution":"UNIFIPMOC University Center","correspondingAuthor":false,"prefix":"","firstName":"Samirah","middleName":"Luiza Barbosa","lastName":"Santos","suffix":""},{"id":557484373,"identity":"eb8a4812-8ea3-47ea-a4b6-0a047fc95a36","order_by":1,"name":"Sarah Costa Prates","email":"","orcid":"","institution":"UNIFIPMOC University 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Coelho","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYBACAzBisEhgYG8AcS2I1iKRwMBzAMSVIEULEIEYhLWYSyRv/PChQiKPX/L51Q0/CiQY+Nu7E/BqsZyRViw544xEseTsnLKbPUCHSZw5uwG/w27kmDHztkkkbridk3aDB6jFQCKXGC3/gFpunkm7+Yd4LQ1ALTfYj90myhbLnmdAvxyTSJzZk8N2W8ZAgoegX8zZQSFWY5PYz3782c03f2zk+Nt78WtBAjwGYJJY5SDA/oAU1aNgFIyCUTCCAADjqUcVOlCVsQAAAABJRU5ErkJggg==","orcid":"","institution":"UNIFIPMOC University Center","correspondingAuthor":true,"prefix":"","firstName":"Bertha","middleName":"Andrade","lastName":"Coelho","suffix":""}],"badges":[],"createdAt":"2025-12-09 03:38:46","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8312678/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8312678/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98441416,"identity":"12a16ef6-e95b-4c58-b3b5-7c7fd461fc57","added_by":"auto","created_at":"2025-12-17 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17:04:21","extension":"html","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101172,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8312678/v1/cf476a0effd45cdfe44d0866.html"},{"id":98388186,"identity":"97c0eda8-a209-4d62-8bd6-b5401d5f4e54","added_by":"auto","created_at":"2025-12-17 09:06:01","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":252127,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy Flowchart\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8312678/v1/5a8e31716c58b93d12362a31.jpg"},{"id":98388187,"identity":"275d0eda-c61a-4aad-82f6-bfd6f5d87af2","added_by":"auto","created_at":"2025-12-17 09:06:01","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":27465,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of histopathological findings obtained through VAE according to the presence of direct cost savings. * Significant difference between groups (p \u0026lt; 0.05), according to the Chi-square test.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8312678/v1/94976199dda756281775baf4.jpg"},{"id":99790186,"identity":"ad85302e-3cce-4d83-9f5c-d72b9cb5fb5e","added_by":"auto","created_at":"2026-01-08 12:57:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1126430,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8312678/v1/65473728-2e2b-428f-a774-00a3aa938d2a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Vacuum-Assisted Excision of Breast Lesions: An Analysis of Costs in the Private Healthcare Sector","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer is the leading malignancy affecting women worldwide and represents an expanding public health challenge, given the continuous rise in incidence, prevalence, and mortality projected for the coming years\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. This scenario places additional pressure on health care systems, intensifying the demand for diagnostic methods that offer accuracy, safety, reduced morbidity, and favorable cost-effectiveness to ensure timely diagnosis and improve clinical outcomes\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eVacuum-assisted excision (VAE) has emerged as a minimally invasive technique capable of providing both diagnostic accuracy and therapeutic excision for a wide spectrum of breast lesions\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. As a percutaneous procedure performed under image guidance and local anesthesia, VAE removes large volumes of tissue through a vacuum-powered needle, allowing complete removal of small to medium breast lesions while minimizing morbidity. Evidence indicates that VAE offers major advantages when compared with conventional surgical excision, especially for benign lesions and lesions of uncertain malignant potential\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Of note, a recent systematic review with meta-analysis of our research group reported no significant difference in local recurrence between VAE and surgical excision for benign phyllodes tumors, reinforcing the procedure safety\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Concerning imaging features, VAE is the preferred technique for small lesions, architectural distortions, calcifications, small intraductal masses, and lesions visible only through mammography or magnetic resonance imaging\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eBecause VAE is performed in an outpatient setting and avoids general anesthesia and hospitalization, it substantially reduces direct and indirect costs. Previous studies indicate that recovery is faster and complication rates are lower than with surgical lumpectomy, and in private health systems or regions with limited resources, VAE may improve accessibility and reduce the burden on surgical services and economic analyses highlight its potential to decrease healthcare expenditure by reducing the need for operating room time and repeated surgeries\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the context of the Brazilian supplementary healthcare sector - characterized by progressively rising surgical costs and the urgent need to optimize resource allocation - there has been a growing adoption of vacuum-assisted excision (VAE). Although the technique has proven to be a highly valuable diagnostic and therapeutic tool in breast disease management, national literature still lacks studies evaluating its direct costs or comparing the economic performance of VAE with that of conventional surgical excision\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven this scenario, the present study aims to analyze the direct costs associated with VAE within the private healthcare sector, exploring its economic implications for supplementary health systems. By doing so, this investigation seeks to provide evidence that supports protocol standardization, enhances patient experience, and optimizes resources allocation in the setting of increasing demand for diagnostic and therapeutic procedures related to breast cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective transversal cohort study compared the direct costs of vacuum-assisted excision (VAE) and diagnostic lumpectomy for the evaluation of suspicious breast lesions. The study was approved by the UNIFIPMoc Research Ethics Committee under protocol number (CAAE) 88693025.3.0000.5109. Women presenting with ultrasound ACR BI-RADS\u0026trade; categories 4 or 5 lesions and undergoing vacuum-assisted excision at a breast unit in Brazil between 2022 and 2024 were included. Data collection was performed through review of electronic medical records using a structured instrument developed by the research team. Patients presenting with lesions classified in categories other than BI-RADS\u0026trade; 4 or 5, VAE procedures performed outside the specified period and incomplete or inconclusive records that prevented statistical analysis were not included. All histopathological and immunohistochemical reports were reviewed. Direct costs of VAE and diagnostic lumpectomy were analyzed and compared based on values established by a specific private healthcare provider, which was used as a reference. The analysis included expenses related to specialist consultations (breast surgeon and anesthesiologist, if needed), breast imaging exams, diagnostic and preoperative tests, and the procedure itself, encompassing physician fees, hospital charges and special material costs. To separate the analyzed groups, we reviewed all imaging studies and asked a key question: \u0026ldquo;Considering the lesion\u0026rsquo;s imaging features and its pathology, did the patient management represented a potential reduction in healthcare expenditures?\u0026rdquo; (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eNormality of continuous variables was assessed using the Shapiro\u0026ndash;Wilk test, which demonstrated that all variables followed a non-parametric distribution. Therefore, continuous variables were summarized using medians and interquartile ranges (P25\u0026ndash;P75), whereas categorical variables were presented as absolute (n) and relative (%) frequencies. For comparative analyses, patients were stratified into the two groups according to the economic outcome of the study: (I) the group that achieved direct cost savings (n\u0026thinsp;=\u0026thinsp;97) and (II) the group without direct cost savings (n\u0026thinsp;=\u0026thinsp;52). Continuous variables were compared between groups using the Mann\u0026ndash;Whitney test, while categorical variables were evaluated using Fisher\u0026rsquo;s Exact test or the Chi-square test. When more than 20% of expected frequencies fell below 5 occurrences, the Chi-square test with Monte Carlo simulation was applied to ensure greater robustness and precision of the estimates. All statistical analyses were performed using Stata\u0026reg; software (version 14.0, Stata Corporation, College Station, TX, USA). Differences were considered statistically significant when p-values were below 0.05 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOf 265 medical records reviewed, 149 patients were included as these were the cases with accessible data and complete pathological assessment. These patients were evaluated to compare the direct costs of vacuum-assisted excision, with or without additional diagnostic or surgical procedures, in the management of suspicious breast lesions. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the clinical characteristics and initial diagnostic trajectory of the included patients.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical and demographic characteristics of patients according to direct cost savings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eDIRECT COSTS SAVING\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge (years) (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (P25 - P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e48 (41\u0026ndash;57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e51,5 (42\u0026ndash;61,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,287 \u003csup\u003eMW\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin - Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e28\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e26\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAge group (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21,15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0,086 \u003csup\u003eQ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43,30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23,08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18,56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28,85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;61 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18,56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26,92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eResidence in Montes Claros? (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67,01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71,15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,604 \u003csup\u003eQ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32,99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28,85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVAE number of fragments (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (P25 - P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15 (12\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e19 (12\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,062 \u003csup\u003eMW\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin - Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e6\u0026ndash;48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePrior Tru-Cut Biopsy? (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21,15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e \u003cb\u003eF\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96,91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e78,85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eUnderwent surgery? (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,000\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e \u003cb\u003eF\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e63,46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eComplications (n\u0026thinsp;=\u0026thinsp;75)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45,83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,292 \u003csup\u003eQ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHematoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41,18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54,17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003en\u003c/sup\u003e absolute frequency; \u003csup\u003e%\u003c/sup\u003e percentage; \u003csup\u003eP25\u003c/sup\u003e 25th percentile; \u003csup\u003eP75\u003c/sup\u003e 75th percentile; \u003csup\u003eMin\u003c/sup\u003e minimum value; \u003csup\u003eMax\u003c/sup\u003e maximum value. \u003csup\u003e*\u003c/sup\u003e Statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); \u003csup\u003eF\u003c/sup\u003e Fisher\u0026rsquo;s Exact test; \u003csup\u003eMW\u003c/sup\u003e Mann\u0026ndash;Whitney test; \u003csup\u003eQ\u003c/sup\u003e Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the comparison between patients who generated direct cost savings (n\u0026thinsp;=\u0026thinsp;97) and those who did not (n\u0026thinsp;=\u0026thinsp;52) the median age, age-group analysis, the municipality of residence and the number of tissue fragments obtained during VAE showed no association with the economic outcome (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Among all variables in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, only two were significantly associated with cost-savings. The first was prior core biopsy: the non-saving group had a substantially higher proportion of patients who had undergone a prior Tru-Cut biopsy (21.15% vs. 3.09%; p\u0026thinsp;=\u0026thinsp;0.001). The second significant variable was whether the patient underwent surgery after the initial diagnosis: none of the patients in the cost-saving group underwent surgery, whereas 36.54% of the non-saving group did (p\u0026thinsp;=\u0026thinsp;0.000). These findings highlight the direct impact of additional diagnostic and therapeutic procedures - particularly prior core biopsy and surgery - on total cost.\u003c/p\u003e \u003cp\u003eAmong the 75 patients with recorded complications, the rate of hematoma did not differ significantly between groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), suggesting that minor adverse events did not affect cost outcomes. Overall, results indicate that the absence of additional procedures - especially the lack of prior core biopsy and the avoidance of surgery - was the primary determinant of direct cost savings. These data reinforce that, in clinical practice, diagnostic strategies that are resolutive and minimize the need for complementary procedures tend to reduce costs and optimize the management of suspicious breast lesions.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the radiological and histopathological characteristics of the breast lesions evaluated in the 149 patients included in the study, compared to the presence or absence of direct cost savings. The aim of this analysis was to determine whether factors related to lesion type, imaging size, or histopathological diagnosis influenced the economic outcome. According to the findings from the lesion-type analysis, the distribution was similar between the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Nodular lesions represented the majority of cases in both groups \u0026minus;\u0026thinsp;63.92% among patients who generated savings and 61.54% among those without savings. The assessment of lesion size on imaging also showed no significant difference between groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as the median measurements were nearly identical (10.5 mm in the savings group vs. 10 mm in the non-savings group), suggesting that, in this study, lesion size did not impact cost outcomes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRadiological and histopathological characteristics of breast lesions according to the presence of direct cost savings.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eDIRECT COST SAVINGS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLesion type (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNodule\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63,92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61,54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0,339 \u003csup\u003eQ\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-nodular lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15,38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14,43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23,08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLesion size on imaging (mm) (n\u0026thinsp;=\u0026thinsp;145)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (P25 - P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10,5 (8\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e10 (8\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,680 \u003csup\u003eMW\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin - Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e3,3\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3,9\u0026ndash;41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHistopathology VAE (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignant lesions(IDC, DCIS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21,15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0,000\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e \u003cb\u003eQ\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eB3 lesions (uncertain malignant potential)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65,98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28,85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBenign lesions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34,02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003en\u003c/sup\u003e absolute frequency; \u003csup\u003e%\u003c/sup\u003e percentage; \u003csup\u003eP25\u003c/sup\u003e 25th percentile; \u003csup\u003eP75\u003c/sup\u003e 75th percentile; \u003csup\u003eMin\u003c/sup\u003e minimum value; \u003csup\u003eMax\u003c/sup\u003e maximum value. \u003csup\u003e*\u003c/sup\u003e Statistically significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); \u003csup\u003eF\u003c/sup\u003e Fisher\u0026rsquo;s Exact test; \u003csup\u003eMW\u003c/sup\u003e Mann\u0026ndash;Whitney test; \u003csup\u003eQ\u003c/sup\u003e Chi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn contrast, a statistically significant difference was observed in the histopathological results obtained through VAE (p\u0026thinsp;=\u0026thinsp;0.000): among patients without cost savings, 21.15% presented malignant lesions (IDC or DCIS), whereas none of the patients in the savings group had a malignant diagnosis on VAE (0.00%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAdditionally, benign lesions were more prevalent in the non-savings group (50.00%) compared with the savings group (34.02%), reflecting a greater proportion of fibroadenomas, adenomas or proliferative lesions without atypia among patients who did not generate cost savings (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This finding, together with the higher rate of surgeries observed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, suggests that some of these patients may have undergone potentially unnecessary surgical procedures, considering that such lesions could have been managed less invasively through VAE.\u003c/p\u003e \u003cp\u003eFinally, the cost-saving group showed a predominance of B3 lesions (65.98%), which contrasts markedly with the non-saving group (28.85%). The findings presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e suggest that the biological behavior of these lesions - rather than its initial radiological appearance - was the main determinant of final cost in the management of suspicious breast lesions in this study.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides a direct comparison of the costs associated with the different diagnostic and therapeutic procedures performed in the 149 patients included in the study, according to whether direct cost savings were achieved. Regarding vacuum-assisted excision (VAE), all patients in both groups underwent the procedure (100.00%), as VAE constituted the initial diagnostic method employed. The approximate cost of VAE was USD\u003cspan\u003e$\u003c/span\u003e 1053.67. In the analysis of Tru-Cut core biopsy, a significant difference was observed between groups (p\u0026thinsp;=\u0026thinsp;0.001): only 3.09% (3/97) of patients who achieved savings required a prior core biopsy, whereas 21.15% (11/52) of those without savings underwent this procedure (Fig.\u0026nbsp;4). This finding indicates that additional diagnostic tests substantially increased costs in the non-saving group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEconomic analysis of procedures according to direct cost savings\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDIRECT COST SAVINGS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eProcedure / Cost (USD\u003cspan\u003e$\u003c/span\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eVacuum Assisted (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97 (100,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (100,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCost (USD$)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1053.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1053.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTru-Cut Core biopsy (n\u0026thinsp;=\u0026thinsp;14)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3,09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (21,15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e \u003cb\u003eF\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCost (USD$)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e195.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e195.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eSurgery (USD$) (n\u0026thinsp;=\u0026thinsp;19)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of patients, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (100,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (36,54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,000\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e \u003cb\u003eF\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCost (USD$)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e---\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e1891.93\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eValor total (R$) (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (P25 - P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1053.67 (1053.67\u0026ndash;1053.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1248.69 (1053.67\u0026ndash;2954.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,000\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e \u003cb\u003eMW\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMin - Max\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1053.67\u0026ndash;1248.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1053.67\u0026ndash;3140.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNotes: \u003csup\u003eF\u003c/sup\u003e = Fisher\u0026rsquo;s Exact test; \u003csup\u003eMW\u003c/sup\u003e = Mann\u0026ndash;Whitney test. \u003csup\u003e*\u003c/sup\u003e Statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Estimated costs based on a private health provider operating in northern Minas Gerais. 1 US Dolar\u0026thinsp;=\u0026thinsp;5,33 BR Real on November 20, 2025.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEven more pronounced differences were observed in the variable \u0026ldquo;Surgery\u0026rdquo; (p\u0026thinsp;=\u0026thinsp;0.000): 36.54% (19/52) of patients in the non-saving group underwent surgery, with an approximate cost of USD\u003cspan\u003e$\u003c/span\u003e 1891.93, while no patient in the savings group required this intervention. This discrepancy directly influenced the final treatment cost and demonstrates that the need for surgery was the primary determinant of the absence of savings (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo identify the clinical profiles most associated with direct cost savings, we analyzed patients according to the distribution of five clinical-economic groups defined by surgical indication, need for core biopsy, and the resolutive capacity of VAE. According to the data presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, there was a statistically significant difference between groups (p\u0026thinsp;=\u0026thinsp;0.000), indicating that the diagnostic and therapeutic pathway taken by each patient directly impacted the final cost. Malignant lesions, which necessarily require surgical treatment, were obviously observed exclusively in the non-saving group (21.15%; 11/52). Likewise, patients who underwent prior core biopsy -which represents an additional expense - were also concentrated in the non-saving group (19.23%; 10/52).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of patients across the five clinical\u0026ndash;economic groups according to the presence of direct cost savings.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e \u003cp\u003eDIRECT COST SAVINGS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e valor\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eClinical Groups (n\u0026thinsp;=\u0026thinsp;149)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalignant lesions (require surgery)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21,15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0,000\u003c/b\u003e\u003csup\u003e\u003cb\u003e* Q\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients who underwent a prior Tru-Cut biopsy (an unnecessary expense)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients for whom the core biopsy alone would have been sufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e44,23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients in whom vacuum procedure was definitive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98,97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients who underwent surgery despite a benign VAE result\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15,38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003en\u003c/sup\u003e absolute frequency; \u003csup\u003e%\u003c/sup\u003e percentage. \u003csup\u003e*\u003c/sup\u003e Significant difference (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05); \u003csup\u003eQ\u003c/sup\u003e Chi-square test with Monte Carlo simulation.\u003c/p\u003e \u003cp\u003ePatients for whom core biopsy alone would have been sufficient formed the majority of the non-saving group (44.23%; 23/52), suggesting unnecessary duplication of diagnostic methods and representing a scenario where VAE was an excess. In contrast, almost all patients in the cost-saving group belonged to the category in which VAE was fully resolutive (98.97%; 96/97), demonstrating the efficiency of VAE as a single-step approach. Furthermore, cases in which surgery was performed despite a benign VAE result occurred only in the non-saving group (15.38%; 8/52), reinforcing the possibility of excessive intervention (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows that direct cost savings were strongly associated with the resolutive nature of VAE and the absence of additional procedures - especially Tru-Cut biopsy and surgery. Conversely, patients who underwent duplicated diagnostic steps, unnecessary surgery, or who presented malignant lesions incurred higher costs. These findings underscore the importance of well-structured clinical protocols to avoid diagnostic redundancy and inappropriate surgeries, thereby optimizing costs and reducing morbidity in the management of suspicious breast lesions.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eVacuum-assisted excision (VAE) has been consolidated as a highly effective minimally invasive technique for both the diagnosis and treatment of breast lesions, allowing the removal of substantial tissue volumes with high precision, diagnostic accuracy, and, frequently, definitive therapeutic intent\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In agreement with these findings, the present study demonstrated a VAE resoluteness rate of 98.97% in the cost-saving group, in which vacuum-assisted excision alone was sufficient as the only therapeutic approach, without the need for additional procedures.\u003c/p\u003e \u003cp\u003eOur results clearly demonstrate the greater economic efficiency of VAE compared with surgical excision for the management of suspicious breast lesions. The cost-saving group presented a fixed mean cost of USD\u003cspan\u003e$\u003c/span\u003e 1053.67, exclusively related to VAE procedure. In contrast, the non\u0026ndash;cost-saving group showed costs ranging from 1248.66 to 3140,62 USD, driven by the need for additional procedures such as prior core needle biopsy and surgery. This difference is explained by the elimination, in resolutive VAE, of expenses related to hospitalization, anesthesia, surgical fees, preoperative examinations, and specialized materials. These findings are consistent with international studies demonstrating that VAE maintains high diagnostic accuracy while significantly reducing costs associated with unnecessary surgical procedures\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, reinforcing its strategic value for the sustainability of private health care systems.\u003c/p\u003e \u003cp\u003eDuplication of diagnostic methods played a central role in increasing costs in the non\u0026ndash;cost-saving group. In this study, 21.15% of patients in this group underwent core needle biopsy before VAE, generating an additional mean increase of approximately USD\u003cspan\u003e$\u003c/span\u003e 195.02 per patient. In well selected patients, the direct use of VAE not only provides higher diagnostic accuracy but also reduces false-negative rates and the final cost of treatment\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEvidence from systematic reviews, international guidelines, and ongoing clinical trials demonstrates that VAE achieves outcomes comparable to surgical excision for multiple lesion types, including benign phyllodes tumors and B3 lesions, while also offering advantages of reduced morbidity, superior cosmetic outcomes, and improved patient satisfaction\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In the present analysis, 65.98% of patients in the cost-saving group who presented B3 lesions on VAE pathology had definitive resolution with vacuum procedure alone. Conversely, in the non\u0026ndash;cost-saving group, 28.85% of patients had B3 lesions, and a proportion of these women underwent surgery despite benign VAE findings, suggesting potential overtreatment. Thus, vacuum-assisted excision proves to be highly resolutive and particularly indicated for benign breast lesions, effectively avoiding unnecessary conventional surgical interventions in these cases.\u003c/p\u003e \u003cp\u003eHistopathological diagnosis also had a direct impact on the economic and therapeutic profile. No patient in the cost-saving group presented malignancy, whereas 21.15% of patients in the non\u0026ndash;cost-saving group were diagnosed with carcinoma (DCIS/IDC) and consequently required surgery. Notably, 15.38% of patients who underwent surgery in the non\u0026ndash;cost-saving group were ultimately diagnosed with benign lesions, reinforcing the hypothesis of overtreatment. This pattern has been widely debated in the literature, which increasingly supports the adoption of VAE as definitive treatment for selected B3 lesions to reduce unnecessary surgeries\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFrom a radiological perspective, no significant association was observed between imaging characteristics and total treatment cost. The type of imaging-detected lesion, with a predominance of nodules in both groups, as well as the mean lesion size (10.5 mm in the cost-saving group and 10.0 mm in the non\u0026ndash;cost-saving group), showed no statistically significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). These findings indicate that cost savings are not primarily dependent on lesion appearance or size but rather on post-diagnostic clinical management, especially regarding the need for additional procedures. Moreover, adverse events were minimal and similarly distributed between groups, with no relevant impact on overall costs.\u003c/p\u003e \u003cp\u003e Our data strongly supports VAE as a strategic tool for private health care systems, demonstrating that its availability can generate economic benefits for both patients and health insurance providers. When VAE is used as the initial resolutive approach, it can represent a significant reduction in healthcare expenditures while also providing an improved patient experience, as previously shown\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. In this context, the high resoluteness rate of VAE (98.97%) directly contributes to reductions in hospital costs, admissions, and additional procedures. Therefore, the systematic incorporation of VAE aligns with international guidelines prioritizing dehospitalization, efficiency of care, and financial sustainability\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, serving as a key instrument for modernizing the breast care model in private health systems. It is also noteworthy that our analysis did not encompass indirect costs associated with these procedures - such as recovery-related expenditures, complications, productivity losses - nor did it incorporate the perspectives of patients who underwent either vacuum-assisted excision or surgical excision.\u003c/p\u003e \u003cp\u003eFinally, emerging studies, including the VAE-BREAST and SMALL trials, suggest that VAE may play a central future role in the therapeutic de-escalation of small, biologically favorable breast cancers\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In addition, national data report significant delays in the initiation of breast cancer treatment\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, a scenario in which VAE may contribute to accelerating diagnostic confirmation and reducing intermediate steps that prolong the time to definitive treatment. Thus, VAE of breast lesions is consolidated not only as an effective diagnostic and therapeutic method but also as a strategic instrument to optimize resources, reduce overtreatment, and enhance the quality of care in health systems.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eVacuum-assisted excision (VAE) demonstrated in this study high clinical efficacy, excellent resoluteness and a clear economic advantage in the management of breast lesions. The use of VAE as the initial therapeutic strategy allowed definitive resolution of most cases, with a significant reduction in the need for additional diagnostic procedures, hospital admissions, and conventional surgeries, directly optimizing health care resources. The results confirm that the observed cost savings were not related to radiological lesion characteristics but rather to post-diagnostic clinical decision-making, particularly the rational use of sequential diagnostic and therapeutic methods.\u003c/p\u003e \u003cp\u003eTherefore, the systematic incorporation of VAE into clinical protocols represents a safe, efficient, and economically sustainable strategy, with the potential to reduce overtreatment, improve the patient experience, and contribute to the modernization of breast health care. This study reinforces the need to expand the use of VAE in the private health care setting and encourages further national research to deepen the evaluation of its clinical, economic, and organizational impact.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential competing interest.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics Approval\u003c/h2\u003e \u003cp\u003e This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Centro Universit\u0026aacute;rio UNIFIPMoc under the number (CAAE) 88693025.3.0000.5109. The study was conducted in accordance with local legislation and institutional requirements. Informed consent was not required since the study was structured as a retrospective analysis of medical records.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThe authors declare no financial support was received for the research and/or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Samirah Luiza Barbosa Santos, Sarah Costa Prates, Victor Eduardo Mendes, Henrique Lima Couto and Bertha Andrade Coelho. The first draft of the manuscript was written by Bertha Andrade Coelho and Henrique Lima Couto and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors thank Doctor Christine Mendes Silveira for reviewing the histopathological examinations and Bruna Torres Silvestre da Silva for specialized assistance with the statistical analysis.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during the current study arere not publicly available due to the presence of sensitive patient information but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCai Y, Dai F, Ye Y et al (2025) The global burden of breast cancer among women of reproductive age: a comprehensive analysis. Sci Rep 15:9347. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41598-025-93883-9\u003c/span\u003e\u003cspan address=\"10.1038/s41598-025-93883-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics, 2021. CA Cancer J Clin 71:7\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21654\u003c/span\u003e\u003cspan address=\"10.3322/caac.21654\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiong X, Zheng LW, Ding Y et al (2025) Breast cancer: pathogenesis and treatments. Signal Transduct Target Ther 10(1):49. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/s41392-024-02108-4\u003c/span\u003e\u003cspan address=\"10.1038/s41392-024-02108-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCouto HL, Coelho BA, Ricardo BFP et al (2025) Vacuum-assisted excision: one-step approach to the diagnosis and percutaneous treatment of small early breast cancer (the VAE-BREAST 01 study protocol). Front Oncol 15:1687634. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2025.1687634\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2025.1687634\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElfgen C, Leo C, Kubik-Huch RA et al (2023) Third International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). \u003cem\u003eVirchows Arch.\u003c/em\u003e ;483(1):5\u0026ndash;20\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGil MLBV, Coelho BA, Couto HL et al (2024) Vacuum-assisted excision: a safe minimally invasive option for benign phyllodes tumor diagnosis and treatment\u0026mdash;a systematic review and meta-analysis. Front Oncol 14:1394116. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2024.1394116\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2024.1394116\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanderink WB, Camps-Herrero J, Athanasiou A et al (2025) Image-guided biopsy of breast lesions\u0026mdash;when to use what biopsy technique. Insights Imaging 16(1):208\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan J, Potter S, Sharma N et al (2019) The SMALL trial: a big change for small breast cancers. Clin Oncol 31(9):659\u0026ndash;663\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLinhares LMAC, Avelar JTC, Alves GR et al (2025) Vacuum-assisted biopsy and excision of breast lesions: review and current indications. Mastology 35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.29289/259453942023047\u003c/span\u003e\u003cspan address=\"10.29289/259453942023047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Society of Breast Surgeons. The Use of Transcutaneous and Percutaneous Ablation for the Treatment of Benign and Malignant Tumors of the Breast. Consensus Guideline (2025) Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-the-Use-of-Transcutaneous-and-Percutaneous-Methods-for-the-Treatment-of-Benign-and-Malignant-Tumors-of-the-Breast.pdf\u003c/span\u003e\u003cspan address=\"https://www.breastsurgeons.org/docs/statements/Consensus-Guideline-on-the-Use-of-Transcutaneous-and-Percutaneous-Methods-for-the-Treatment-of-Benign-and-Malignant-Tumors-of-the-Breast.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed November 28, 2025\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhitworth P, Hogan A, Ferko N et al (2020) Reduced hospital costs for ultrasound-guided vacuum-assisted excision compared with open surgery in patients with benign breast masses and high-risk lesions. J Breast Imaging 2(5):452\u0026ndash;461. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/jbi/wbaa055\u003c/span\u003e\u003cspan address=\"10.1093/jbi/wbaa055\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan de Voort EMF, Struik GM, van Streun SP et al (2022) Hospital costs and cosmetic outcome of benign and high-risk breast lesions managed by vacuum-assisted excision versus surgical excision. Br J Radiol 95(1136):20220117. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1259/bjr.20220117\u003c/span\u003e\u003cspan address=\"10.1259/bjr.20220117\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Li J, Mo M et al (2023) The comparison of efficacy and safety evaluation of vacuum-assisted Elite 10-G system and the traditional BARD 14-G core needle in breast diagnosis: an open-label, parallel, randomized controlled trial. Int J Surg 109(5):1180\u0026ndash;1187. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/JS9.0000000000000257\u003c/span\u003e\u003cspan address=\"10.1097/JS9.0000000000000257\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCouto HL, Valadares CN, Soares AN et al (2025) Vacuum-assisted biopsy in the era of low-risk ductal carcinoma in situ active monitoring: real world data and implications. Front Oncol 15:1618476. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2025.1618476\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2025.1618476\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinder SE, Shaaban AM, Deb R et al (2018) NHS Breast Screening multidisciplinary working group guidelines for the diagnosis and management of breast lesions of uncertain malignant potential on core biopsy (B3 lesions). Clin Radiol 73(8):682e1\u0026ndash;682e7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan de Voort EMF, Struik GM, van Streun SP et al (2020) Patient-reported cosmetic outcome after vacuum-assisted excision of benign breast lesions: a cross-sectional study. Br J Radiol 93(1114):20190994. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1259/bjr.20190994\u003c/span\u003e\u003cspan address=\"10.1259/bjr.20190994\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDong Y, Huang Y, Qiu L, Yang Y, Feng W, Shi XQ (2025) Predictive model for hematoma formation following ultrasound-guided excision of benign breast lesions. J Surg Res 305:275\u0026ndash;285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jss.2024.11.047\u003c/span\u003e\u003cspan address=\"10.1016/j.jss.2024.11.047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElder K, Coles C, Dodwell D et al (2025) SMALL: open surgery versus minimally invasive vacuum-assisted excision for small screen-detected breast cancer\u0026mdash;protocol for a phase III randomised multicentre trial. BMJ Open 15(4):e099702. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjopen-2025-099702\u003c/span\u003e\u003cspan address=\"10.1136/bmjopen-2025-099702\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFigueiredo CL, Mendes PHC, Caldeira AP, Lucena CEM, Coelho BA (2025) Breast cancer treatment delay associated factors in Northern Minas Gerais. Cad Sa\u0026uacute;de Colet 33(1):e33010155. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/1414-462X202533010155\u003c/span\u003e\u003cspan address=\"10.1590/1414-462X202533010155\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vacuum-assisted excision, Cost-analyses, Minimally invasive procedures, Breast surgical overtreatment","lastPublishedDoi":"10.21203/rs.3.rs-8312678/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8312678/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eIntroduction:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOverdiagnosis and overtreatment have become central issues in the current debate on breast cancer screening and management. Breast cancer remains the most prevalent malignancy among women worldwide, imposing a substantial clinical and economic burden. In this context, vacuum-assisted excision (VAE) has emerged as an effective diagnostic and therapeutic alternative for suspicious breast lesions, offering lower morbidity and potential cost reduction compared with conventional surgery. In Brazil, particularly within the private healthcare sector, national evidence evaluating the direct economic impact of VAE remains scarce. Therefore, this study aimed to analyze the direct costs associated with the use of VAE in the management of suspicious breast lesions in the private healthcare sector.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA retrospective cohort study was conducted including women with BI-RADS\u0026trade; 4 or 5 lesions who were submitted to VAE between 2022 and 2024. A total of 149 patients with complete clinical and pathological data were analyzed. The analysis included medical fees, diagnostic tests, surgical procedures, and costs of special materials. Clinical, radiological, and histopathological variables were evaluated.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAge, radiological features, and lesion size did not significantly influence overall costs. Prior core needle biopsy and the need for surgery were the main determinants of increased expenses. In the cost-saving group (n\u0026thinsp;=\u0026thinsp;97), 98.97% of cases were definitively managed with VAE alone, without the need for surgery. In the non\u0026ndash;cost-saving group (n\u0026thinsp;=\u0026thinsp;52), 36.54% of patients underwent surgery. Median total cost in the cost-saving group was USD 1,053.67, while in the non\u0026ndash;cost-saving group it reached up to USD 3,140.62.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDiscussion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eVacuum-assisted excision proved to be a highly resolutive, safe, and economically advantageous strategy for the management of suspicious breast lesions in the private healthcare setting. The absence of additional procedures - especially prior core needle biopsy and surgery - was the main factor associated with cost savings. These findings reinforce the role of VAE in reducing surgical overtreatment, optimizing resource allocation, and modernizing breast care delivery. Our results support the systematic incorporation of VAE into clinical protocols within private healthcare, benefiting both patients and healthcare providers.\u003c/p\u003e","manuscriptTitle":"Vacuum-Assisted Excision of Breast Lesions: An Analysis of Costs in the Private Healthcare Sector","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 09:05:56","doi":"10.21203/rs.3.rs-8312678/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d900bdf-4aa6-4b0f-ae0f-2a74aec4b3ac","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-04T20:38:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 09:05:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8312678","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8312678","identity":"rs-8312678","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}