Maria L. Gil ¹ Bertha Andrade Coelho ^2,3 Henrique L. Couto ^2,4,5* Henrique M. Silva ¹ Eduardo C. Pessoa ^5,6,7 Nisha Sharma ⁸ Ritse Mann ⁹ Stuart A. Mcintosh ¹⁰ Paulo Diniz ^1,11 Farley S. Cantidio ¹ Gabriel O. Gil ¹ Anna D. Salvador ¹ Waldeir J. Almeida Júnior ¹ José T. Avelar ¹ Cláudia L. Laranjeiras ¹ Agnaldo L. Silva Filho ^12,13,5

• ¹ Materdei Hospital, Belo Horizonte, Mato Grosso, Brazil
• ² Brazilian Society of Mastology, Belo Horizonte, Mato Grosso, Brazil
• ³ UNIFIMOC University Center, Montes Claros, Brazil
• ⁴ Redimama - Redimasto Breast Unit., Belo Horizonte, Mato Grosso, Brazil
• ⁵ Brazilian Federation of Associations of Gynecologists and Obstetricians, Rio de Janeiro, Brazil
• ⁶ Brazilian Society Mastology, São Paulo, Rio Grande do Sul, Brazil
• ⁷ Faculty of Medicine, Sao Paulo State University, Botucatu, Brazil
• ⁸ Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
• ⁹ Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, the Netherlands Cancer Institute, Amsterdan, Netherlands
• ¹⁰ The Patrick G Johnston Centre for Cancer Research, Faculty of Medicine, Health and Life Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
• ¹¹ Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Mato Grosso, Brazil
• ¹² Department of Obstetrics and Gynecology, Botucatu Medical School, Sao Paulo State University-UNESP, Botucatu,, Botucatu, Brazil
• ¹³ Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Brazil

this is a systematic review and meta-analysis comparing surgical excision and percutaneous ultrasound-guided vacuum assisted excision (US-VAE) for treatment of benign phyllodes tumor (PT) using local recurrence (LR) as the endpoint.Objective: To determine the frequency of LR of benign PT after US-VAE compared to the frequency of LR after surgical excision.Method: Systematic review and meta-analysis (following the PRISMA standard) comparing LR in women older than 18 years old treated for benign PT by US-VAE compared with local surgical excision, with at least 12 months follow up. Studies were retrieved from PubMed, Scopus, Web of Science and Embase. The pooled effect measure used was the odds ratio (OR) of recurrence.Results: Five comparative prospective or retrospective observational studies published between 01/01/1992 and 01/10/2022, comparing surgical excision and percutaneous ultrasound-guided vacuum assisted excision (US-VAE) for local recurrence (LR) of benign phyllodes tumor (PT) met the selection criteria. Four were retrospective observational cohorts and one was a prospective observational cohort. In total 778 women were followed. Of these, 439 (56,4%) underwent local surgical excision and 339 (43,6%) patients had US-VAE. The median age of patients in the 5 studies ranged from 33,7 to 39 years old; the median size ranged from 1,5cm to 3,0cm and the median follow up ranged from 12 to 46,6 months. Needle gauge ranged from 7G to 11G. LR rates were not statically significant between US-VAE and surgical excision (41 of 339 versus 34 of 439; OR 1.3; p = 0.29).Conclusion: This meta-analysis suggests that using US-VAE for removal of benign PT does not increase local regional recurrence and is a safe minimally invasive therapeutic option.