What is vacuum-assisted breast biopsy?
Vacuum-assisted biopsy of the breast is a minimally invasive, image-guided procedure that obtains breast tissue samples for histological diagnosis. The biopsy system is partially mechanised and vacuum assisted, i.e. there is a vacuum suction to draw the breast tissue into the biopsy needle.

Why do I need this procedure?
This is to obtain tissue from breast lesions for analysis to determine if it is benign or cancerous. Vacuum-assisted biopsy is highly accurate, especially for breast calcifications and small lesions requiring investigation.

What does it involve?
Vacuum-assisted biopsy is minimally invasive and performed with local anaesthesia. The procedure is usually done on an outpatient basis. Fasting and sedation are not required.

The biopsy may be performed under mammographic (stereotactic), ultrasound or magnetic resonance imaging (MRI) guidance:

1. In mammographic-guided (stereotactic) biopsy, the area requiring biopsy will be located using x-rays from a mammogram unit. Your breast will be firmly compressed as in a mammogram for the procedure.
2. In ultrasound-guided biopsy, the lesion or area requiring biopsy will be targeted using an ultrasound probe. 
3. In MRI-guided biopsy, the biopsy will be performed in an MRI machine.

Local anaesthesia will be used to numb the breast, followed by a small skin incision to allow placement of the biopsy needle in the breast. Only a small skin incision is necessary, leaving minimal residual scarring. Under radiological guidance (stereotactic, ultrasound or MRI), the biopsy needle is directed towards the breast lesion. An automated mechanism is then activated for strips of breast tissue (usually 12-24 samples) to be removed by the biopsy needle. Following biopsy, a small metallic clip may be placed in the breast if the lesion is no longer apparent under imaging. It is useful to mark the biopsied area in the event that subsequent surgery is required. If no surgery is required, this metallic clip will be left in the breast and does not need to be removed. It is not known to cause any significant problems when left in the breast.

What precautions must I take for the procedure?
Please inform your doctor if you have any medical illnesses. Before the procedure, please inform your doctor if any of the following are applicable:

1. You have a history of allergy or reaction to any medications, drugs, or food.
2. You have a history of bleeding or clotting disorders.
3. You are taking drugs (e.g. Aspirin, Clopidogrel, Warfarin and Rivaroxaban) or supplements (e.g. Cordyceps, Gingko Biloba and Lingzhi), that thin your blood, as these substances may be blood clotting and increase the risk of bleeding. If you are taking any of these, your doctor will advise you accordingly.
4. You are pregnant.
   

What are the risks and complications of the procedure?
Vacuum-assisted biopsy is generally safe. The overall complication rate is less than 5% and serious complications are rare. Potential complications include:

Pain
Pain is minimised with the use of local anaesthesia. There will be some discomfort or pain for a few days after the procedure but this is usually well tolerated with oral painkillers.

Bleeding/Haematoma
Patients may experience some bleeding during and after the biopsy (5 – 10%). This normally stops following compression over the biopsy site. The risk of severe bleeding requiring surgery is very low (less than 1%).

Infection
The risk of post-biopsy infection is very low (less than 1%) and usually resolves with antibiotics.

Others
There is a chance of technical failure in some cases. The breast volume may be too thin for insertion of the biopsy needle or risk accidental suction and injury of the skin. The breast lesion may be in a position that is not accessible for biopsy. Sometimes, a biopsied lesion may not be sampled adequately, resulting in inconclusive histological evaluation (less than 5%). The patient’s primary physician will then discuss if a re-biopsy is required and if alternative biopsy procedures are necessary.

What can I expect after procedure?
A small wound dressing with overlying pressure bandage will be applied to the breast. The pressure bandage may be removed after one day and the wound dressing may be removed after three days. You should keep the pressure bandage dry and avoid bathing until it is removed the next day. Mild discomfort and staining on the wound dressing at the biopsy site may be expected. There may be some bruising in the overlying skin. This generally disappears in 1-2 weeks. If there is continuous bleeding from the wound, apply firm pressure over the wound for about 20 minutes. If bleeding continues, you should seek medical attention. Avoid strenuous activities (e.g. carrying heavy loads and swimming) for three days. There should be no problems with routine housework or office work.

What are my options?
Alternative biopsy procedures include core needle biopsy and open surgical biopsy.

Core needle biopsy is also a minimally invasive method where a smaller biopsy needle is also used to remove breast tissue for histology. However, it is non-vacuum assisted and smaller breast samples are obtained. It may be less accurate in obtaining a histological diagnosis.

Open surgical biopsy involves removal of the breast lesion by operation, usually under general anaesthesia. The skin incision is bigger and may result in internal scarring which can affect future mammographic and ultrasound interpretation.

The breast lesion may also be followed-up in certain circumstances over a period of time, to see if it progresses. However, this may result in delay in diagnosis and treatment of the breast disease. You are encouraged to discuss the alternatives and management with your doctor so that the most suitable procedure may be performed based on your clinical condition.