Performing a breast biopsy with a directional, vacuum-assisted biopsy instrument.

A recently developed method of minimally invasive breast biopsy involves use of a directional, vacuum-assisted instrument. Use of this instrument requires some changes in techniques and applications of breast biopsy, but it enables confident biopsy of breast lesions under both ultrasound (US) and stereotactic guidance. The device uses vacuum to pull tissue into the probe and to remove the specimen without withdrawing the probe each time. For stereotactic biopsy, to target the lesion, the probe is placed anterior or posterior to the lesion and stereotactic positioning views are obtained; for a US-guided procedure, the probe is advanced posterior to the lesion. Next, the direction that the probe aperture must be rotated to face the lesion is determined. Tissue samples are obtained at consecutive clock positions of 1 1/2-hour intervals to achieve contiguous sampling. At least 15 samples are obtained with an 11-gauge probe to acquire a minimum of 1,500 mg of tissue. If postbiopsy images reveal that the lesion has been removed, a percutaneous clip is placed to mark the biopsy site for follow-up examination and possible further treatment. Patients are examined the next day and given the biopsy results and treatment considerations, if needed; they are followed up approximately 1 week later to detect any complications (eg, discomfort, ecchymosis). By learning how to perform a directional, vacuum-assisted biopsy with either stereotactic or US guidance, the radiologist has an additional, valuable tool for bringing accurate breast biopsy to his or her community.