In most cases, a fine needle aspiration is chosen when the lump is likely to be filled with fluid. If the lump is easily accessible or if the doctor suspects that it may be a fluid-filled cystic lump, the doctor may choose to conduct a fine-needle aspiration (FNA). During this procedure, the lump should collapse once the fluid inside has been drawn and discarded. Sometimes, an ultrasound is used to help your doctor guide the needle to the exact site, whereby sound waves create a picture of the inside of the breast. If the lump persists, the surgeon or radiologist, a doctor who specializes in medical imaging such as x-rays and mammograms, will perform a fine needle aspiration biopsy (FNABx), a similar procedure using the needle to obtain cells from the lump for examination.

Core needle biopsy is the procedure to remove a small amount of suspicious tissue from the breast with a larger “core” (meaning “hollow”) needle. It is usually performed while the patient is under local anesthesia, meaning the breast is numbed. During the procedure, the doctor may insert a very small marker inside the breast to mark the location of the biopsy. If surgery is later required, the marker makes it easier for the surgeon to locate the abnormal area. Even if no further treatment such as surgery is needed, the marker allows a breast imaging radiologist to see on future mammograms where the biopsy was done. The radiologist or surgeon performing the core-needle biopsy may use specialized imaging equipment to guide the needle to the desired site. As with fine-needle aspiration, this may involve ultrasound. During an ultrasound-guided core needle biopsy, the patient lies down while the doctor holds the ultrasound against the breast to direct the needle. On the other hand, during a stereotactic-guided core-needle biopsy, the doctor uses x-ray equipment and a computer to guide the needle. Typically, the patient is positioned lying on the stomach on a special table that has an opening for the breast, and the breast is compressed, similar to a mammogram. Occasionally, no imaging equipment is used, but this is typically only in cases where the lump can be felt through the skin. This type of procedure is called a freehand core-needle biopsy. There are fewer side effects associated with a core-needle biopsy than with surgical biopsy. Nowadays, percutaneous imaging-guided breast biopsy is a reliable alternative to surgical biopsy for a histological diagnosis [1–5]. Percutaneous biopsy is less invasive than surgery, can be performed quickly, does not deform the breast, causes minimal scarring, complications (haematoma and infection) are infrequently found (less than one case in 1,000), fewer surgeries are needed for patients who undergo percutaneous biopsies and therefore the cost of diagnosis is lower [1–5]. There are two main objectives of percutaneous biopsy techniques: first, achieving the maximum degree of accuracy and second, offering as much information as possible about the tumour (type, grade, invasion, hormonal receptors, HER-2 NEU, etc.). To achieve these objectives, the percutaneous biopsy devices have evolved, from fine-needle aspiration cytology towards core-needle biopsy (CNB) and later vacuum-assisted biopsy (VAB) [1]. Nowadays, ultrasound-guided core needle breast biopsy has become the first choice for performing a percutaneous biopsy for most lesions seen on ultrasound [1, 6–9]. Virtually any breast lesion that is clearly seen on ultrasound can be sampled under ultrasound guidance [6]. Many surgical biopsies that had to be carried out in the past, because of suspicious radiological findings, are nowadays unnecessary due to the extensive use of ultrasound NCB. In addition, surgical specimens removed after a previously proven malignant result are usually more adequate for the tumour size. Consequently, the number of surgical procedures has also been reduced for malignant lesions. Thus, the number of surgical procedures has drastically decreased both for benign and malignant lesions, thanks to the extensive use of ultrasound CNB and the other methods of percutaneous biopsy. The technique was first described by Parker and co-workers in the early 1990s, and nowadays ultrasound CNB has become the first choice for performing most breast biopsies [2, 4, 5, 9].

Current indications and contraindications

All lesions classified as BI-RADS 4 and 5, clearly visible on ultrasound, are amenable to ultrasound CNB [6]. This technique can also be used for some BI-RADS 3 lesions under certain circumstances: genetic or family risk, medical or social difficulties for follow-up, pregnancy, extreme anxiety and others, including the patient’s decision. Ultrasound CNB can be difficult in patients with severe psychiatric disorders, which makes them impossible to collaborate on, and is contraindicated in some cases of severe blood dyscrasia. However, there are no statistically significant differences in haematoma formation between patients taking anticoagulant therapy daily and non-treated patients [11]. Thus, it is not necessary to stop that therapy to perform an ultrasound CNB. Expert radiologists can perform biopsies of very deep lesions located close to the pectoral muscle in large breasts. Obtaining a biopsy in some patients with silicone implants can be also contraindicated. Palpable lesions can be safely biopsied under ultrasound guidance. Although surgeons have been using CNB guided by palpation for a long time [12], the accuracy is increased with ultrasound guidance [13]. As well as diagnostic objectives, ultrasound guidance allows us to perform other interesting therapeutic procedures such as evacuation of liquid or semi-solid collections and placement of markers or coils for neoadjuvant chemotherapy. More recently, ultrasound guidance has been useful for tumour ablation using radiofrequency, cryoablation, laser therapy or focused ultrasound [14–16].

An advance minimally invasive technique for precise diagnosis and complete removal of benign breast lump without Surgery

Key features of VABB:

Why VABB is Done?

Stereotac c VABB:To determine whether an abnormal area on mammogram is benign or malignant e.g.

• Tiny clusters of microcalcifica ons.
• A small area of architectural distor on.
• Asymmetric density on mammogram.
• A new small mass or nodule or a newer area of microcalcifica ons in a previous surgery site.

ULTRASOUND guided VABB : Very small lesions difficult to target with Core needle biopsy

• Discordant pathological – radiological findings.
• A small area of architectural distor on.
• Non mass like lesions / ductal lesions like suspected ductal carcinoma in situ or suspected lobular carcinoma.
• Papillary lesions.

MRI Guided VABB diagnos c indica ons:

• Indicated only in MRI visible lesions.
• A small area of architectural distor on.
• Suspicious non mass enhancement visible only on MRI