Vacuum-Assisted Core Biopsy

Authors: Dr Joanne Lazberger*
                            A/Prof Liz Wylie *

What are the prerequisites for having a vacuum-assisted core biopsy done?

Recent previous imaging that has identified an abnormality requiring vacuum-assisted core biopsy must be available prior to the procedure, for planning purposes.

If the patient is of childbearing age, pregnancy status should be indicated. A negative pregnancy test result should be available.

What are the absolute contraindications for a vacuum-assisted core biopsy?

There are no absolute contraindications to vacuum-assisted core biopsy unless it is to be performed under MRI guidance. In that circumstance, the usual contraindications to MRI apply (e.g. pacemakers and metallic bodies). Patients with severe kidney impairment may not be able to have contrast with their MRI.

What are the relative contraindications for a vacuum-assisted core biopsy?

Anticoagulation is a relative contraindication. However, if anticoagulants cannot be safely discontinued prior to the procedure, it is possible to perform the procedure after advising the woman she is at increased risk of bruising / haematoma.

If the procedure is to be performed using a prone table or MRI:

• There is a weight restriction for the prone stereotactic biopsy table which may prevent obese patients having the procedure.
• Respiratory or other conditions (e.g. large anterior abdominal wall hernia) that may limit ability to lie prone will make the procedure more difficult or impossible.

16. What are the adverse effects of a vacuum-assisted core biopsy?

The risks of vacuum-assisted core biopsy are:

• Infection. Less than 1 in 1000 patients will develop infection. This usually requires only antibiotic treatment (capsules taken at home) but drainage (ultrasound guidance or surgical incision) may be necessary in the very small number of those who get infection and go on to develop an actual abscess.
• Haematoma. A large bruise or collection of blood clot in the breast will affect less than 1 in 100 patients. If this occurs, it usually resolves with conservative management. It rarely requires percutaneous or surgical drainage.

Are there alternative imaging tests, interventions or surgical procedures to a vacuum-assisted core biopsy?

Vacuum-assisted core biopsy is usually performed if an imaging abnormality is:

• a small (<5 mm) cluster of calcifications on mammogram;
• a small mass only identified on mammogram (i.e. not on ultrasound and not detectable by feeling the breast with an examining hand);
• a small mass only seen on MRI.

Or if:

• a previous core biopsy (14 g) was considered non-diagnostic (based on the triple test).

Further information about vacuum-assisted core biopsy:

The advantages of vacuum-assisted core biopsy are:

• minimally invasive;
• it takes about 1 hour;
• outpatient procedure under local anaesthesia;
• quick recovery and return to normal activities;
• minimal scarring that has no / minimal impact on interpreting subsequent breast imaging;
• avoids surgery for benign lesions.

The disadvantages of vacuum-assisted core biopsy are:

• some lesions (especially very posterior lesions) are not accessible for biopsy;
• there is a small risk of pneumothorax if the lesion is very deep and adjacent to the chest wall (very rare complication);
• occasionally lesion histology is inconclusive.

The alternative biopsy procedure is an open surgical biopsy. This is usually indicated if:

• vacuum-assisted core biopsy is inconclusive;
• lesion is not accessible for vacuum-assisted core biopsy.

*The author has no conflict of interest with this topic.

Page last modified on 26/7/2017.