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To compare the performance of prone digital breast tomosynthesis (DBT)-vacuum-assisted biopsy (VA with prone stereotactic-guided VAB (sVA, focusing on time of procedure, number of expositions, average glandular dose, and complications. The institutional review board approved this retrospective study and informed consent was waived. From July 2015 to January 2017, 306 patients with 306 suspicious mammographic findings (BI-RADS ⩾4) underwent mammography-guided biopsy, prone sVAB, or prone DBT-VAB. Student test, chi-square, and multiv