Study-level factors associated with hematoma after ultrasound-guided vacuum-assisted breast lesion excision: a systematic review and meta-analysis using a T-P-B framework.

Objective: To systematically summarize study-level factors associated with postoperative hematoma after ultrasound-guided vacuum-assisted breast lesion excision(VAE) using a vacuum-assisted breast biopsy (VABB) system, and to organize the available evidence according to a novel T-P-B framework comprising tumor-related, position-related, and breast- or peri-procedural management-related factors. Methods: A systematic search was conducted in PubMed, China National Knowledge Infrastructure, Wan fang Data, VIP Database, and Elsevier Clinical Key for studies published between January 1995 and October 2025. Observational studies investigating risk factors for hematoma after VAE using a VABB system were included. Study-derived exposure categories and cutoff values were retained. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using R (version 4.5.1). Effect sizes were expressed as odds ratios (ORs) with corresponding 95% confidence intervals (CIs) and were pooled using the inverse-variance method. Heterogeneity was assessed using the I² statistic, and a random-effects model was applied. Sensitivity analysis was conducted by sequentially excluding individual studies (leave-one-out analysis). A two-sided Results: A total of 11 retrospective studies involving 3,516 patients who underwent VAE using a VABB system were included, among whom 444 cases of postoperative hematoma were reported. Five study-level factors were identified. Meta-analysis demonstrated that, within the T dimension, tumor numbers (OR = 4.21, 95% CI = 2.59-6.85), numbers of cutting passes(OR=3.87,95%CI=2.16-6.95)were significantly associated with hematoma formation. Within the P dimension, non-moderate tumor depth, including superficial or deep tumor, was associated with postoperative hematoma (OR = 4.39, 95% CI: 1.21-15.92), as was higher vascularity grade (OR = 2.60, 95% CI: 1.42-4.76). Within the B dimension, postoperative compression duration <48 h was associated with hematoma formation (OR = 4.34, 95% CI: 2.53-7.45). Sensitivity analyses showed generally consistent directions of association. Conclusions: This systematic review and meta-analysis identified five study-level factors associated with postoperative hematoma after VAE using a VABB system: tumor numbers, a higher number of cutting passes, non-moderate tumor depth including superficial or deep tumor, higher vascularity grade, and postoperative compression duration <48 h. The T-P-B framework may provide a clinically interpretable structure for organizing these factors and informing perioperative risk assessment.