https://pmc.ncbi.nlm.nih.gov/articles/PMC4115763/

In the era of precision medicine, the treatment plans for breast cancer increasingly rely on detailed molecular pathological information. The quality of biopsy samples directly determines the reliability of the test results. This article compares the performance of vacuum-assisted biopsy (VABB) and traditional core needle biopsy (CNB) from three aspects: sample integrity, cell abundance, and RNA/DNA preservation.

I. Sample Integrity and Preservation of Organizational Structure

CNB relies on spring cutting. During the high-speed advancement, the samples are prone to being damaged by shear force and torsion force, resulting in fragmentation and deformation of the tissues. Especially for breast tissues rich in fat, the CNB samples often appear as "noodle-like" distortions, making it difficult to distinguish the normal ducts and lobular structures under the microscope. The vacuum suction of VABB enables the tissues to smoothly enter the sample chamber, and then they are neatly cut by the rotating cutting sleeve, resulting in tissue cores in a cylindrical shape with distinct structural layers. Manners Company uses the cutting sleeve processed by the Citizen L12-1M7 centering lathe, with an inner hole tolerance of ±0.01 mm, and the cutting edge is sharpened through electrolytic polishing to minimize tissue tearing.

II. Cell Abundance and Immunohistochemical Feasibility

Immunohistochemistry (IHC) staining requires a sufficient number of tumor cells to accurately assess the ER, PR, and Ki-67 indices. The number of tumor cells in a single sample from CNB is often between 200 and 500, and for low cell density tumors (such as lobular carcinomas), there may be false-negative results. VABB can obtain 10 to 20 samples in a single operation, with a total cell count of several thousand to tens of thousands, significantly improving the positive detection rate of IHC. A meta-analysis including 800 patients showed that the failure rate of ER/PR detection with VABB was only 0.8%, while that with CNB was 3.2%.

III. Nucleic Acid Quality and Compatibility with Genetic Testing

The integrity of RNA and DNA is a prerequisite for the success of next-generation sequencing (NGS). In CNB samples, due to prolonged exposure to air and repeated punctures, cell apoptosis occurs, resulting in significant RNA degradation. The sealed collection system of VABB directly sends the samples into the fixative or RNA protection solution, and the vacuum environment reduces oxidative stress. In addition, the 316L stainless steel material used by VABB (compliant with RoHS and ISO 13485) does not contain heavy metal ions, avoiding the risk of metal catalyzing nucleic acid degradation. For patients who need to detect germline mutations of BRCA1/2 or tumor mutation burden (TMB), the DNA yield and quality of VABB samples are superior to those of CNB.

IV. Recovery Rate of Microcalcifications

Microcalcification is an important indicator of ductal carcinoma in situ (DCIS). After obtaining the sample through core needle biopsy (CNB), X-ray radiography is often required to confirm whether the calcification is included. If no calcification is observed, additional puncture is necessary. Vascular-assisted aspiration biopsy (VABB) can remove the entire suspicious area and then search for calcification from the removed specimen, with a recovery rate exceeding 95%. This is crucial for the accurate grading (nuclear grade, necrosis) of DCIS and the assessment of surgical margins.

Conclusion

The quality of pathological samples is the first link in the diagnostic chain. VABB, with its advantages of continuous sampling, vacuum protection, and precise cutting, leads CNB comprehensively in terms of tissue integrity, cell abundance, and nucleic acid preservation. As precision medicine increasingly demands higher standards for biopsy samples, VABB is evolving from an "optional solution" to a "standard configuration".