Two-year follow-up of stereotactically guided 9-G breast biopsy: a multicenter evaluation of a self-contained vacuum-assisted device

Published:February 26, 2009DOI:



      To evaluate the performance of a self-contained, battery-driven, vacuum-assisted breast biopsy (VABB) system for the sampling of clustered breast microcalcifications and masses under stereotactic guidance.

      Methods and materials

      A total of 144 patients (median age: 56 years; range: 21–87 years) in four European breast centers underwent percutaneous 9-gauge (G), stereotactic-guided VABB. The median lesion size was 11 mm (range 2–60 mm). Patients were biopsied in the prone (n=125) or upright position (n=19). All patients were followed up for at least 24 months.


      The stereotactic procedure was successful in 142 (98.6%) of 144 cases, with two cases cancelled due to either severe patient motion (one case) or failure to detect faint calcifications (one case). A median of 12 specimens per procedure was obtained. In 39 cases (27.5%), the suspicious lesion could no longer be detected mammographically after the biopsy procedure. The histological diagnosis was malignancy in 45 (31.7%) cases. One case of atypical ductal hyperplasia diagnosed preoperatively was upgraded to ductal carcinoma in situ (DCIS) at operation, giving an overall sensitivity of 97.7% for the vacuum-assisted biopsy procedure. In two cases where DCIS was diagnosed at vacuum-assisted biopsy, the malignant tissue was apparently completely removed and could no longer be found at operation. No serious complications occurred. During the follow-up period, no breast cancers appeared at the location of biopsy. Six patients dropped out during the follow-up period.


      The self-contained, vacuum-assisted biopsy device is well suited for stereotactically guided breast biopsies, having demonstrated excellent sensitivity and specificity in the preoperative workup of mammographically detected breast lesions after 2 years of follow-up.


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        • Cady B
        Breast cancer in the third millennium.
        Breast J. 2000; 6: 280-287
        • Hieken TJ
        • Harrison J
        • Herreros J
        • Velasco JM
        Correlating sonography, mammography, and pathology in the assessment of breast cancer size.
        Am J Surg. 2001; 182: 351-354
        • Heywang-Koebrunner SH
        • Viehweg P
        Sensitivity of contrast-enhanced MR imaging of the breast.
        Magn Reson Imaging Clin N Am. 1994; 2: 527-538
        • Kaiser WA
        • Zeitler E
        MR Imaging of the breast: fast imaging sequences with and without Gd-DTPA. Preliminary observations.
        Radiology. 1989; 170: 681-686
      1. Ikeda DM, Birdwell RL, Daniel BL. Potential role of magnetic resonance imaging and other modalities in ductal carcinoma in situ detection. Magn Reson Imaging Clin N Am 2001; 9:345-356, vii.

        • Neubauer H
        • Li M
        • Kuehne-Heid R
        • Schneider A
        • Kaiser WA
        High grade and non-high grade ductal carcinoma in situ on dynamic MR mammography: characteristic findings for signal increase and morphological pattern of enhancement.
        Br J Radiol. 2003; 76: 3-12
        • Pfarl G
        • Helbich TH
        • Riedl CC
        • et al.
        Stereotactic 11-gauge vacuum-assisted breast biopsy: a validation study.
        AJR Am J Roentgenol. 2002; 179: 1503-1507
        • Jackman RJ
        • Nowels KW
        • Rodriguez-Soto J
        • Marzoni FA
        • Finkelstein SI
        • Shepard MJ
        Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up.
        Radiology. 1999; 210: 799-805
        • Dershaw DD
        Imaging guided biopsy: an alternative to surgical biopsy.
        Breast J. 2000; 6: 294-298
        • Heywang-Kobrunner SH
        • Schaumloffel U
        • Viehweg P
        • Hofer H
        • Buchmann J
        • Lampe D
        Minimally invasive stereotaxic vacuum core breast biopsy.
        Eur Radiol. 1998; 8: 377-385
        • Pisano ED
        • Fajardo LL
        • Caudry DJ
        • et al.
        Fine-needle aspiration biopsy of nonpalpable breast lesions in a multicenter clinical trial: results from the radiologic diagnostic oncology group V.
        Radiology. 2001; 219: 785-792
        • Heywang-Kobrunner SH
        • Heinig A
        • Pickuth D
        • Alberich T
        • Spielmann RP
        Interventional MRI of the breast: lesion localisation and biopsy.
        Eur Radiol. 2000; 10: 36-45
        • Pfleiderer SO
        • Reichenbach JR
        • Azhari T
        • Marx C
        • Wurdinger S
        • Kaiser WA
        Dedicated double breast coil for magnetic resonance mammography imaging, biopsy, and preoperative localization.
        Invest Radiol. 2003; 38: 1-8
        • Schulz-Wendtland R
        • Kramer S
        • Lang N
        • Bautz W
        Ultrasonic guided microbiopsy in mammary diagnosis: indications, technique and results.
        Anticancer Res. 1998; 18: 2145-2146
        • Schoonjans JM
        • Brem RF
        Fourteen-gauge ultrasonographically guided large-core needle biopsy of breast masses.
        J Ultrasound Med. 2001; 20: 967-972
        • Smith DN
        • Rosenfield Darling ML
        • Meyer JE
        • et al.
        The utility of ultrasonographically guided large-core needle biopsy: results from 500 consecutive breast biopsies.
        J Ultrasound Med. 2001; 20: 43-49
        • Liberman L
        • Sama MP
        Cost-effectiveness of stereotactic 11-gauge directional vacuum-assisted breast biopsy.
        AJR Am J Roentgenol. 2000; 175: 53-58
        • Helbich TH
        • Rudas M
        • Haitel A
        • et al.
        Evaluation of needle size for breast biopsy: comparison of 14-, 16-, and 18-gauge biopsy needles.
        AJR Am J Roentgenol. 1998; 171: 59-63
        • Brem RF
        • Schoonjans JM
        • Goodman SN
        • Nolten A
        • Askin FB
        • Gatewood OM
        Nonpalpable breast cancer: percutaneous diagnosis with 11- and 8-gauge stereotactic vacuum-assisted biopsy devices.
        Radiology. 2001; 219: 793-796
        • Liberman L
        • Smolkin JH
        • Dershaw DD
        • Morris EA
        • Abramson AF
        • Rosen PP
        Calcification retrieval at stereotactic, 11-gauge, directional, vacuum-assisted breast biopsy.
        Radiology. 1998; 208: 251-260
        • Philpotts LE
        • Shaheen NA
        • Carter D
        • Lange RC
        • Lee CH
        Comparison of rebiopsy rates after stereotactic core needle biopsy of the breast with 11-gauge vacuum suction probe versus 14-gauge needle and automatic gun.
        AJR Am J Roentgenol. 1999; 172: 683-687
        • Liberman L
        Clinical management issues in percutaneous core breast biopsy.
        Radiol Clin North Am. 2000; 38: 791-807
        • Schulz-Wendtland R
        • Kramer S
        • Bautz W
        First experiences with a new vacuum-assisted device for breast biopsy.
        Rofo. 2003; 175: 1496-1499
        • Vag T
        • Pfleiderer SO
        • Bottcher J
        • et al.
        Ultrasound-guided breast biopsy using a 10-gauge self-contained vacuum-assisted device.
        Eur Radiol. 2007; 17: 3100-3102
        • Burbank F
        Stereotactic breast biopsy of atypical ductal hyperplasia and ductal carcinoma in situ lesions: improved accuracy with directional, vacuum-assisted biopsy.
        Radiology. 1997; 202: 843-847
        • Donaldson LA
        • Cliff A
        • Gardiner L
        • Hubbard AE
        • Ashton MA
        Surgeon-controlled ultrasound-guided core biopsies in the breast—a prospective study and a new use for surgeons in the clinic.
        Eur J Surg Oncol. 2003; 29: 139-142
        • Liberman L
        • Fahs MC
        • Dershaw DD
        • et al.
        Impact of stereotaxic core breast biopsy on cost of diagnosis.
        Radiology. 1995; 195: 633-637
        • Daniel BL
        • Freeman LJ
        • Pyzoha JM
        • et al.
        An MRI-compatible semiautomated vacuum-assisted breast biopsy system: initial feasibility study.
        J Magn Reson Imaging. 2005; 21: 637-644
        • Nisbet AP
        • Borthwick-Clarke A
        • Scott N
        11-Gauge vacuum assisted directional biopsy of breast calcifications, using upright stereotactic guidance.
        Eur J Radiol. 2000; 36: 144-146
        • Jackman RJ
        • Burbank F
        • Parker SH
        • et al.
        Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: improved reliability with 14-gauge, directional, vacuum-assisted biopsy.
        Radiology. 1997; 204: 485-488
        • Jackman RJ
        • Burbank F
        • Parker SH
        • et al.
        Stereotactic breast biopsy of nonpalpable lesions: determinants of ductal carcinoma in situ underestimation rates.
        Radiology. 2001; 218: 497-502
        • Apesteguia L
        • Mellado M
        • Saenz J
        • Cordero JL
        • Reparaz B
        • De Miguel C
        Vacuum-assisted breast biopsy on digital stereotaxic table of nonpalpable lesions non-recognisable by ultrasonography.
        Eur Radiol. 2002; 12: 638-645
        • Jackman RJ
        • Birdwell RL
        • Ikeda DM
        Atypical ductal hyperplasia: can some lesions be defined as probably benign after stereotactic 11-gauge vacuum-assisted biopsy, eliminating the recommendation for surgical excision?.
        Radiology. 2002; 224: 548-554
        • Liberman L
        • Vuolo M
        • Dershaw DD
        • et al.
        Epithelial displacement after stereotactic 11-gauge directional vacuum-assisted breast biopsy.
        AJR Am J Roentgenol. 1999; 172: 677-681
        • Lee CH
        • Carter D
        • Philpotts LE
        • et al.
        Ductal carcinoma in situ diagnosed with stereotactic core needle biopsy: can invasion be predicted?.
        Radiology. 2000; 217: 466-470
        • Lee CH
        • Egglin TK
        • Philpotts L
        • Mainiero MB
        • Tocino I
        Cost-effectiveness of stereotactic core needle biopsy: analysis by means of mammographic findings.
        Radiology. 1997; 202: 849-854
        • Liberman L
        • Gougoutas CA
        • Zakowski MF
        • et al.
        Calcifications highly suggestive of malignancy: comparison of breast biopsy methods.
        AJR Am J Roentgenol. 2001; 177: 165-172