This is a monocentric retrospective observation performed from 1st January 2018 to 1st August 2020, in which we examined the medical records and image storage systems available to the breast radiology of 1500 patients with indeterminate palpable and non-palpable nodular mass of the breast and undergoing subsequent biopsy interventional radiology procedure. Collected data include: age, family history for mammary and gynecological cancers, blood count, coagulation index, anticoagulation and antiplatelet therapy, size and site of the mass, palpable or non-palpable nodule. The study inclusion criteria are: mass greater than 5 mm in maximum diameter, not palpable target lesions, lesions visualized only on tomosynthesis, lesions classified according to ACR BI-RADS with grade 4 and 5, use of 9G needle, execution of 12 standard samples, absence of drug-allergy to anesthetics. No structural features were used to select the tomosynthesis guided biopsy instead of surgical excision. The exclusion criteria are: echo-detectable mass, palpable mass, thrombocytopenia, coagulopathy. Written informed consent on the risks and benefits of the procedure was obtained from all patients prior to the surgery which was performed in accordance with national and European guidelines. The study was approved by the Institutional Review Board. The operators who performed the survey have more than 15 years of experience in interventional breast radiology. The examination is performed on an outpatient basis. Coagulation and platelet counts were monitored for each procedure; SIR-CIRSE guidelines for bleeding risk procedures were followed 13. The intake of clopidogrel and aspirin was suspended 5 days before the procedure. Anticoagulants were suspended according to drug kinetic and drug dynamic profile. No antibiotics were administered in accordance with current protocols. The tomosynthesis device used for the study was a Giotto plus. Interventional procedures were performed with a standard 9 gauge or petite vacuum breast biopsy device (Eviva; Hologic, Bedford, Massa). In all patients, 12 tissue samples were taken clockwise. The biopsy was performed with a mammograph (Giotto Plus I.M.S.) and a special system to place the patient in the prone position. After positioning the patient, breast compression was applied in the direction that allowed the shortest access to the target lesion (FIG 1-2). The target lesion window of the biopsy was checked by acquiring tomosynthesis scout images. The operator has identified the area of interest within the 3D volume tomosynthesis file. The coordinates were automatically determined by the biopsy software system after that the operator indicated the target location with a cursor (FIG 3). After skin disinfection, deep local anesthesia with 10 mL of lidocaine was performed at the target lesion site. The mechanical guide provides motorized movement for centering the target in the X and Y planes. The Z axis (depth) was adjusted manually. Then a small incision was made with a scalpel at the site of the anesthetic puncture. The '' pre-fire '' phase consisted of loading the biopsy needle and performing a new scan to document the needle in the appropriate position (FIG 4). The displacement of the target could be caused by the anesthetic. If necessary, the needle position was corrected. Subsequently, the needle was inserted up to the target and two biopsy rotations were performed clockwise. The collected material was placed on a slide for a 2D mammography check in another location to document the sampling performed. All the samples obtained were placed in neutral 10% formalin buffer and sent for pathological analysis. After that, a non-magnetic metal clip was implanted and tomosynthetic control of the same and any hematoma was performed (FIG 5). Manual compression was performed for 15 minutes and steri clips were placed in the site of the skin breach. Thereafter, clinical and ultrasound control was performed at 90 minutes. Tomosynthesis exam was performed after 10 days to evaluate the location of the implanted clips and the evolution of the hematoma (FIG 6-7). The procedural factors evaluated are the following: safety of the procedure by assessing the frequency of vaso-vagal reactions, hematomas, short-term bleeding (up to 10 days). The Evaluated technical success was considered as a conclusive sample for histological diagnosis. Complications were assessed according to the CIRSE Standard for Classification of Complications 13. We subsequently evaluated statically significant differences between high-contrast lesions (microcalcifications) and low-contrast lesions (architectural distortions) and between lesions <or = at 10 mm and> 10 mm. We also evaluated the average procedural time. Finally, we evaluated the frequency of the obtained histological data and compared them with the existing literature. All statistics were developed in MATLAB® (Mathematics Works, Inc., Natick, Massachusetts, USA). We also performed a comparison between procedural data from interventions in patients with high-contrast lesions (microcalcifications) and low-contrast lesions (architectural distortions) and between lesions <o = 10mm and> 10m: the differences in terms of safety and efficacy were considered statistically significant if p-value <0.05, using Student's t-test or Wilcoxon signrank test.