Therapeutic applications of vacuum biopsy

Core biopsy is now established as the first-line method for breast biopsy and sensitivity for carcinoma of 90–95% can be achieved. The quest for 100% accuracy of percutaneous biopsy has led to the development of very large core biopsy methods; vacuum assisted mammotomy (VAM) is the most successful and widely used of these methods. VAM is available in 14, 11 and 8 gauge sizes (36, 100 and 300 mg per core). The 8-g probe has been developed specifically for attempted complete removal of small breast lesions. VAM is not suitable for excision of malignant lesions but has a role in the removal for diagnosis of borderline lesions and removal of confirmed benign lesions at the patient's request. Borderline lesions suitable for VAM removal are papillary lesions, mucocele-like lesions and radial scars. Nipple discharge associated with intraduct papilloma can also be treated by this method. VAM can also be used to excise fibroadenomas up to 30 mm in diameter. VAM is well tolerated and has very few complications. For therapeutic excision VAM is significantly cheaper than surgical biopsy.