MR-guided vacuum biopsy allows reliable and safe histological verification of “MR only” visible lesions with high accuracy and reaches a diagnostic accuracy equivalent or even higher to that of MR-guided needle localization followed by open surgery. Vacuum-assisted biopsy is advantageous over MR-guided automatic core biopsy for MR-guided percutaneous breast biopsy, because vacuum-assisted biopsy can be performed quickly, removes a large volume of tissue, provides more accurate histological characterization, especially of lesions containing ADH, and DCIS. Today, many international recommendations for breast MRI request that all sites performing breast MRI need to offer MR-guided vacuum biopsies for histological proof of MR-only visible lesions. If the MR-biopsy cannot be performed at the institution itself, it collaborates with a neighboring center where MR-guided procedures are performed.