Vacuum Biopsy – Treatment, Effects & Risks

Biopsies are tissue samples followed by histological, cytological or laboratory chemical analysis. Biopsy is used in the context of various tissue changes and has mainly diagnostic purposes. Open biopsy procedures are distinguished from closed forms of biopsy. The closed forms of biopsy correspond to minimally invasive and thus gentle procedures. One such procedure is vacuum biopsy. In principle, this biopsy procedure is a further development of conventional needle biopsy, which in itself is already one of the minimally invasive procedures.

In vacuum biopsy, tissue is sucked in by a needle by means of negative pressure and removed from the body for subsequent analysis. Stereotactically supported vacuum biopsies of the breast have been around since 1996, when Burbank and Parker first used the technique in the United States. In Europe, the method was used for the first time in 1997.

Applications

The most common indications for vacuum biopsy are changes in the female breast and suspicious tissue changes of the prostate. The most relevant role is played by the removal of tissue in the context of cancer diagnostics. Only the histology of the removed sites provides reliable information about the benignity or degree of malignancy of tumors.In the case of female breasts, the BI-RADS criteria apply in this context. Probably benign lesions only need to be examined in patients with a corresponding risk profile. Probably malignant findings always require a histological diagnosis before removal.

Microcalcifications, i.e. minimal calcium deposits, can hardly be clarified using other methods. Therefore, biopsy in this case remains the only diagnostic option. Depending on the size of a tissue change, other deposits may not be satisfactorily clarified and therefore require a biopsy. Since the patient should not be unnecessarily burdened, minimally invasive procedures are preferably used for the indication for biopsies.

Vacuum biopsy is one of the gentlest biopsy procedures and is therefore preferable as far as possible to other sampling techniques. Contraindications arise with insufficient blood clotting, as well as findings near the skin.

Methods and procedures

Prostate vacuum biopsy and breast vacuum biopsy are the best-known procedures of suction biopsy. Common to both areas of application are the components of tissue removal. In addition to an intervention needle to penetrate the biopsy area, an inner cutting cannula is required to trigger tissue. In addition, the vacuum biopsy includes a driver that hangs with gears on the intervention needle and moves the cannula back and forth in circular motions for the incision. The heart of every vacuum biopsy is the vacuum pump, which generates negative pressure in the biopsy chamber. The sucked tissue is separated from the tissue mesh by a tiny knife and then sent to the laboratory, where histological, cytological or laboratory chemical analysis is performed. Cytological means concerning the cells. Histological means concerning the tissue.

What does the patient have to consider?

On the day of a vacuum biopsy, patients must be fasting. Apart from clear water, they are not allowed to eat anything. The risks and side effects of the procedure as well as all relevant instructions on how to behave are provided by their attending physician.

As a rule, sampling requires inpatient admission to the clinic despite the gentle process technology. Although the examined patients can usually return to their normal everyday life immediately after removal of the affected tissue, they must avoid exertion such as sports or similar stress for at least 24 hours.

The tiny incision used for tissue sampling via vacuum biopsy is in most cases protected with a simple pressure bandage. Larger follow-up examinations are usually not necessary. In addition, the bandage does not have to be changed in most cases, but is removed again immediately.

If there is pain or other changes in the biopsied area, patients must come for a follow-up check-up. In all other cases, the minimal incision heals within a very short time. Patients should not drive until about two hours after the biopsy, as their circulation is still weakened by the local anesthetic. Depending on the findings, major surgery to remove malignant tissue changes may be required after the vacuum biopsy.

Implementation – How does the vacuum biopsy work?

Tissue is removed from patients during vacuum biopsy under local anesthesia . Patients with breast changes lie prone on a Fischer table, which allows the affected breast to hang down freely and allows compression of the breast perpendicular to the thoracic wall. Due to the puncture direction, the tissue change can be reached in the shortest possible way. The respective change in the tissue is shown by means of a straight image recording as well as recordings tilted to the left and to the right in order to determine the depth of the tissue abnormality. The puncture angle and puncture depth are then calculated in order to precisely reach the lesion with a hollow needle.

After making an incision in the skin, the biopsy needle advances to the previously determined coordinates. Stereotactic target recordings allow verification of the correct position.The doctor then pierces the lesion with the biopsy needle until it reaches the height of the extraction window. The open biopsy window generates a vacuum suction in area 1, which pulls the adjacent tissue inside the needle.

A rotating knife separates the tissue. A suction in the vacuum area 2 transports the cut biopsy to the rear end of the needle, where it can be removed. A sample is taken from several locations in this way. The doctor closes the skin wound with a plaster.

Who bears the costs?

If indicated, vacuum biopsies are covered by statutory and private health insurance companies. The prerequisite for this is the medical necessity of tissue removal. The attending physician confirms this necessity.

Risks and complications

General anesthesia is not required for vacuum biopsy. The sampling leaves no visible scars or tissue defects. The pain after the operation is also limited. Nevertheless, in extreme cases, hematoma formation, infections or allergic reactions to the local anesthetic can occur. However, given the high standards of Western medicine, such complications are extremely unlikely to occur. At most, Headaches , slight nausea and Circulatory problems are to be feared as side effects on the day of the procedure.