ObjectiveThe present study was performed to assess the accuracy and clinical value of image-guided vacuum-assisted breast biopsy in the diagnosis of mammography-detected breast microcalcifications.MethodsThis prospective study involved 100 patients with suspicious mammography-detected microcalcifications who underwent image-guided vacuum-assisted breast biopsies from January 2013 to October 2016. Stereotactic vacuum-assisted breast biopsy (SVAB) was performed in 64 patients, and ultrasound (US)-guided vacuum-assisted breast biopsy (US-VAB) was performed in 36 patients in whom application of SVAB was difficult. The microcalcifications were detectable by mammography or US. The mean follow-up duration was 32 months (range, 9–57 months). The biopsy results were correlated with the pathological examination results.ResultsThe positive predictive value of microcalcifications detected by mammography and US in the diagnosis of breast cancer was 37.0% (37/100) and 52.8% (19/36), respectively. The negative predictive value of microcalcifications detected by US in the diagnosis of breast cancer was 71.9% (46/64). No recurrence was observed in the 37 patients with breast cancer. No evidence of malignancy was found among the 63 patients with benign lesions.ConclusionImage-guided vacuum-assisted breast biopsy is accurate and minimally invasive. It can be used as a safe approach for diagnosis in patients with breast microcalcifications.