What is Vacuum-Assisted Biopsy?
The relatively new vacuum-assisted
breast biopsy is a percutaneous ("through the skin") procedure that relies on
stereotactic mammography or ultrasound
imaging. Stereotactic mammography uses computers to pinpoint the exact location
of a breast mass based on mammograms (x-rays) taken from two different angles. The
computer coordinates will help the physician to guide the needle to the correct area in
the breast. With ultrasound, the radiologist or surgeon will watch the needle on the
ultrasound monitor to help guide it to the area of concern. The patient will either by
positioned in the upright or prone (face down) position for a
vacuum-assisted biopsy.
Vacuum-assisted biopsy is a minimally
invasive procedure that allows for the removal of multiple tissue samples. However, unlike
core needle biopsy, which involves several separate needle
insertions to acquire multiple samples, the special biopsy probe used during
vacuum-assisted biopsy is inserted only once into the breast through a small skin nick
made in the skin of the patient's breast.
Two companies currently manufacturer
vacuum-assisted breast biopsy systems, and often, vacuum-assisted biopsy will be referred
to by the brand name: either Mammotome
made by Johnson & Johnson Ethicon Endo-Surgery or MIBB (which stands for Minimally Invasive Breast Biopsy) made by
Tyco/United States Surgical Corporation. In 1999, a hand-held version of the Mammotome was
also approved by the U.S. Food and Drug Administration (FDA).
How is Vacuum-Assisted Biopsy
Performed?
First, the skin of the breast is
cleaned. Then, a small amount of local anesthetic (lidocaine), similar to what one might
have at a dentist’s office, is injected into the skin and deeper tissues of the
breast using a small hypodermic needle. Under stereotactic or ultrasound guidance, the
radiologist or breast surgeon positions the special breast probe into the area of the
breast where the lesion (abnormality) is located.
After the probe has been properly
positioned, a vacuum line draws the breast tissue through the aperture of the probe into
the sampling chamber of the device. Once the tissue is in the sampling chamber, the
rotating cutting device is advanced and a tissue sample is captured. The tissue sample is
then carried through the probe to the tissue collection area (a standard pathology tissue
cassette).
After a tissue sample is captured, the
radiologist or surgeon then rotates the thumbwheel of the probe, moving the sampling
chamber approximately 30 degrees to new position. The entire cycle is repeated, until all
desired areas have been sampled (typically, eight to 10 samples of breast tissue are taken
360 degrees around the lesion).
When a sufficient number of tissue samples have been collected, the radiologist or surgeon
will remove the probe and apply pressure to the biopsy site. An adhesive bandage will be
applied to the skin nick. In some cases, a small sterile clip will be placed into the
biopsy site of the breast to mark the location in case a future biopsy is needed. This
microclip is left inside the breast and causes no pain, disfigurement, or harm to the
patient. After the biopsy is complete, the tissue samples will be sent to the pathology
laboratory for diagnosis.
CONTINUED
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