ObjectivesTo analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB.MethodsWe performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided.ResultsMRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35).ConclusionMRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings.Key points• Three vacuum-assisted breast biopsy (VAB) procedures were compared.• Technical success rates were high for all three VAB procedures.• Medical complications were relatively low using all three VAB procedures.• The use of MRI-guided vacuum-assisted breast biopsy is growing.