K Number
K202012
Date Cleared
2020-08-18

(28 days)

Product Code
Regulation Number
876.1075
Reference & Predicate Devices
Predicate For
N/A
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdpartyExpeditedreview
Intended Use

The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is indicated to provide tissue samples for diagnostic sampling of breast abnormalities.
· The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is intended to provide breast tissue for histologic examination with partial or complete removal of the imaged abnormality.
· The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is intended to provide breast tissue for histologic examination with partial removal of a palpable abnormality.

The extent of a histologic abnormality cannot always be readily determined from palpation or imaged appearance. Therefore, the extent of removal of the palpated or imaged evidence of an abnormality does not predict the extent of removal of a histologic abnormality, e.g., malignancy. When the sampled abnormality is not histologically benign, it is essential that the tissue margins be examined for completeness of removal using standard surgical procedures. In instances when a patient presents with a palpable abnormality that has benign through clinical and/or radiological criteria (e.g., fibroadenoma, fibrocystic lesion), the Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System may also be used to partially remove such palpable lesions. Whenever breast tissue is removed, histological evaluation of the tissue is the standard of care. When the sampled abnormality is not histologically benign, it is essential that the tissue margins be examined for completeness of removal using standard surgical procedures.

Device Description

The Mammotome revolve EX System is an electromechanical breast biopsy device indicated to provide tissue samples for diagnostic sampling of beast abnormalities for histologic examination.

The Mammotome revolve EX System is comprised of three primary subsystems:

    1. a sterile, single-use Probe
    1. a reusable Holster, and
    1. a reusable control unit.
AI/ML Overview

The Mammotome revolve EX System is an electromechanical breast biopsy device. The provided text describes conformity with various performance tests, but it does not contain details of a clinical study with acceptance criteria for diagnostic performance (e.g., sensitivity, specificity, or accuracy) or a comparative effectiveness study involving human readers.

Here's an analysis of the provided information, focusing on what is available and explicitly noting the absence of details requested in some points:

1. Table of Acceptance Criteria and Reported Device Performance

The document describes several non-clinical bench performance tests where the acceptance criterion was "PASSED." The specific numerical acceptance criteria for each test (e.g., maximum acceptable bacterial count for sterility) are not detailed, only the outcome.

Acceptance Criteria CategoryReported Device Performance
Sterility TestingPASSED
Biocompatibility TestingPASSED
Software Verification and Validation TestingPASSED
Electrical Safety and Electromagnetic Compatibility (EMC) TestingPASSED
Animal Lab Study (Tissue Sample Testing - Sample Weight, Sample Reliability, Sample Quality)PASSED
Usability TestingPASSED

Note: This table reflects the non-clinical tests reported. Clinical diagnostic performance acceptance criteria (e.g., sensitivity/specificity for abnormality detection) are not provided or assessed in this document.

2. Sample Size Used for the Test Set and Data Provenance

The document describes non-clinical bench testing, animal lab studies, and software verification/validation. It does not refer to a "test set" in the context of human patient data for diagnostic performance.

  • Test Set Sample Size: Not applicable for diagnostic performance as described in the provided text, which focuses on device functionality and safety.
  • Data Provenance: The animal lab study uses an animal model, but no specific country of origin is mentioned. The other tests are bench tests or software validation. All are likely controlled laboratory or in-house tests. The studies are described as "Non-Clinical Bench Performance Testing," implying retrospective analysis of these tests was performed for this submission.

3. Number of Experts Used to Establish Ground Truth for the Test Set and Qualifications

This information is not provided in the document. For a diagnostic device, ground truth would typically be established by expert interpretation or pathology, which is not described.

4. Adjudication Method for the Test Set

This information is not provided because a clinical test set with diagnostic adjudication is not described.

5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study

No Multi-Reader Multi-Case (MRMC) comparative effectiveness study is mentioned in the provided text. The document focuses on demonstrating substantial equivalence to a predicate device through non-clinical performance and safety testing.

6. Standalone Performance Study

No standalone diagnostic performance study (algorithm only without human-in-the-loop performance) is described. The device is a biopsy system, meaning it collects samples for diagnosis, but its own diagnostic performance (like an AI system for image interpretation) is not assessed here. The standalone performance studies relate to the device's functional integrity (e.g., sterility, electrical safety, software function, tissue sampling in an animal model).

7. Type of Ground Truth Used

For the animal lab study's tissue sample testing, the "ground truth" implicitly relates to the properties of the tissue samples collected (e.g., weight, reliability, quality). However, the specific method for establishing this ground truth (e.g., histological examination of collected animal tissue, quantitative measurements) is not explicitly detailed beyond "Tissue Sample Testing - Sample Weight - Sample Reliability - Sample Quality."

For other tests (sterility, biocompatibility, software, electrical safety), the ground truth is defined by the technical specifications and recognized standards (e.g., ISO standards for sterility and biocompatibility).

8. Sample Size for the Training Set

Not applicable. This document describes a medical device, not an AI/ML model that requires a training set of data for diagnostic purposes. The software mentioned is for controlling the device's functions, not for diagnostic interpretation based on learned patterns from a dataset.

9. How the Ground Truth for the Training Set Was Established

Not applicable, as there is no training set for an AI/ML model described in this document.

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Image /page/0/Picture/0 description: The image shows the logo for the U.S. Food and Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services logo on the left and the FDA logo on the right. The FDA logo is in blue and includes the letters "FDA" in a square and the words "U.S. FOOD & DRUG ADMINISTRATION".

August 18, 2020

Devicor Medical Products, Inc. % Prithul Bom Most Responsible Person Regulatory Technology Services, LLC 1000 Westgate Drive, Suite #510k Saint Paul, Minnesota 55114

Re: K202012

Trade/Device Name: Mammotome Revolve Dual Vacuum Assisted Biopsy (VAB) System Regulation Number: 21 CFR 876.1075 Regulation Name: Gastroenterology-urology biopsy instrument Regulatory Class: Class II Product Code: KNW Dated: July 20, 2020 Received: July 21, 2020

Dear Prithul Bom:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely.

Long Chen, Ph.D. Assistant Director DHT4A: Division of General Surgery Devices OHT4: Office of Surgical and Infection Control Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

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DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration

Indications for Use

Form Approved: OMB No. 0910-0120 Expiration Date: 06/30/2020 See PRA Statement below.

510(k) Number (if known)

K202012

Device Name

Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System

Indications for Use (Describe)

The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is indicated to provide tissue samples for diagnostic sampling of breast abnormalities.

· The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is intended to provide breast tissue for histologic examination with partial or complete removal of the imaged abnormality.

· The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is intended to provide breast tissue for histologic examination with partial removal of a palpable abnormality.

The extent of a histologic abnormality cannot always be readily determined from palpation or imaged appearance. Therefore, the extent of removal of the palpated or imaged evidence of an abnormality does not predict the extent of removal of a histologic abnormality, e.g., malignancy. When the sampled abnormality is not histologically benign, it is essential that the tissue margins be examined for completeness of removal using standard surgical procedures. In instances when a patient presents with a palpable abnormality that has benign through clinical and/or radiological criteria (e.g., fibroadenoma, fibrocystic lesion), the Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System may also be used to partially remove such palpable lesions. Whenever breast tissue is removed, histological evaluation of the tissue is the standard of care. When the sampled abnormality is not histologically benign, it is essential that the tissue margins be examined for completeness of removal using standard surgical procedures.

Type of Use (Select one or both, as applicable)
☑ Prescription Use (Part 21 CFR 801 Subpart D) ☐ Over-The-Counter Use (21 CFR 801 Subpart C) ☑ Prescription Use (Part 21 CFR 801 Subpart D) ☐ Over-The-Counter Use (21 CFR 801 Subpart C)
☑ Prescription Use (Part 21 CFR 801 Subpart D) ☐ Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.
This section applies only to requirements of the Paperwork Reduction Act of 1995.#### *DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW."

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

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Image /page/3/Picture/1 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized, light blue graphic element on the left, resembling two crescent shapes facing each other. To the right of this graphic is the word "DEVICOR" in bold, black, sans-serif font. Below "DEVICOR" is the text "MEDICAL PRODUCTS, INC." in a smaller, lighter font.

510(k) Summary

The following information is provided as required by 21 CFR § 807.92 for the Mammotome revolve EX System 510(k) premarket notification. In response to the Safe Medical Devices Act of 1990 the following is a summary of the safety and effectiveness information upon which the substantial equivalence determination is based.

K202012

Company:

Devicor Medical Products, Inc. 300 E-Business Way, Fifth Floor Cincinnati, OH 45241 Establishment Registration Number: 3008492462

Contact:

Gwendolyn Payne Regulatory Affairs Manager Devicor Medical Products, Inc. 300 E-Business Way, Fifth Floor Cincinnati, OH 45241 Ph: 513-864-9186 Fax: 513-864-9011 E-mail: Gwendolyn.Payne@mammotome.com

Date of Submission: June 9, 2020

Proprietary Name: Mammotome revolve EX

Common Name: Biopsy System

Regulation: 21 CFR 876.1075

Regulatory Class: II

Product Codes: KNW

Classification Name: Biopsy Instrument

Predicate Device: Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System, K152989

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Page 2 of 9

Image /page/4/Picture/3 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized, light blue graphic to the left of the company name. The word "DEVICOR" is written in bold, black letters, with "COR" in a lighter blue color. Below "COR" is the text "MEDICAL PRODUCTS, INC." in a smaller font, also in light blue.

Device Description: The Mammotome revolve EX System is an electromechanical breast biopsy device indicated to provide tissue samples for diagnostic sampling of beast abnormalities for histologic examination.

The Mammotome revolve EX System is comprised of three primary subsystems:

    1. a sterile, single-use Probe
    1. a reusable Holster, and
    1. a reusable control unit.

Intended Use: The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is indicated to provide tissue samples for diagnostic sampling of breast abnormalities.

  • . The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is intended to provide breast tissue for histologic examination with partial or complete removal of the imaged abnormality.
  • 0 The Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System is intended to provide breast tissue for histologic examination with partial removal of a palpable abnormality.

The extent of a histologic abnormality cannot always be readily determined from palpation or imaged appearance. Therefore, the extent of removal of the palpated or imaged evidence of an abnormality does not predict the extent of removal of a histologic abnormality, e.g., malignancy. When the sampled abnormality is not histologically benign, it is essential that the tissue margins be examined for completeness of removal using standard surgical procedures.

In instances when a patient presents with a palpable abnormality that has been classified as benign through clinical and/or radiological criteria (e.g., fibroadenoma, fibrocystic lesion), the Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System may also be used to partially remove such palpable lesions. Whenever breast tissue is removed, histological evaluation of the tissue is the standard of care. When the sampled abnormality is not histologically benign, it is essential that the tissue margins be examined for completeness of removal using standard surgical procedures.

Technological Characteristics:

The Mammotome revolve EX System facilitates the diagnostic removal of tissue through a combination of vacuum and rotational/translational cutting functions. The Mammotome

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Image /page/5/Picture/4 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized, light blue graphic to the left of the company name. The word "DEVICOR" is written in bold, black letters, with the "OR" in light blue. Below the company name, in smaller light blue letters, is the text "MEDICAL PRODUCTS, INC."

revolve EX System utilizes the same primary subsystems as identified in the predicate device to achieve its intended use:

    1. a sterile single use Probe containing a trocar tipped biopsy needle, rotating cutter, specimen collection chambers, and vacuum tubing/valving;
    1. a reusable Holster, containing the drive motors, gear trains, and user activation switches; and
    1. a reusable Control Module, containing the vacuum pump, power supply, valve actuators, user interface touchscreen, control electronics, and software.

In addition, several optional accessories that function with the EX system are available as part of the total Mammotome revolve Dual Vacuum Assisted Biopsy (VAB) System including remote keypad and footswitch controls, a transport cart, and a holster holder for the new EX Holster.

The Mammotome revolve Vacuum Assisted Biopsy (VAB) System has been updated to integrate the new EX system while maintaining the basic technology, functionality and clinical outcomes of the predicate system. Consistent with the Mammotome revolve Dual VAB US System, the EX system is configured for use in the Ultrasound imaging modality.

The system relies on software to operate many of its functions including utilization of closed loop control on cutter position. In both the EX and predicate software systems, the focus of the software is to aid in system set-up and facilitate biopsy functions. The Mammotome revolve EX System software has been updated to include functionality with the new EX Probe.

A side-by-side comparison of the marketed and proposed devices is provided below.

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Image /page/6/Picture/3 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized, light blue symbol resembling two crescent moons facing each other. To the right of the symbol, the word "DEVICOR" is written in bold, black letters, with the "COR" portion in a lighter blue color. Below "DEVICOR", the words "MEDICAL PRODUCTS, INC." are written in a smaller, sans-serif font.

Side-by-Side Comparison to Legally Marketed Device

Table 1a: Side-by-Side Comparison of Mammotome revolve EX Holster and Control Module to previous Mammotome revolve ST and U/S Holsters and Control Module

DeviceCharacteristics:Holster / ControlModuleMarketed Device:Mammotome revolve(ST and U/S) BiopsySystem (K152989)Proposed Device:Mammotome revolve(EX) Biopsy SystemComparison:Same, Similiarities, andDifferences withSupporting Rationale
Indications for UseBreast Biopsy / complete,partial removal of imagedabnormality /partialremoval of palpatedabnormalityBreast Biopsy / complete,partial removal of imagedabnormality /partialremoval of palpatedabnormalitySame
User interfaceMechanismsButtons on Holster, Buttonson Remote Keypad, Pedalson Footswitch, TouchscreenButtons on Holster, Buttonson Remote Keypad, Pedalson Footswitch, TouchscreenSame
Microprocessor andupgradeable softwareYesYesSame
DisplayYes, LCD displayYes, LCD displaySame
Translational CutterMovementAutomaticAutomaticSame
Rotational CutterMovementAutomatic with cutteradvancementAutomatic with cutteradvancementSame
Rotational andTranslation SpeedcontrolYes, Closed loop controlYes, Closed loop controlSame
Drive Train TypeOn board Motor and GearTrainOn board Motor and GearTrainSame
Independent Lateraland Axial VacuumSystemYesYesSame
Remote Footswitch /Keypad CapabilityYesYesSame
DeviceCharacteristics:ProbesMarketed Device:Mammotome revolve(ST and U/S) BiopsySystem (K152989)Proposed Device:Mammotome revolve(EX) Biopsy SystemComparison:Same, Similiarities, andDifferences withSupporting Rationale
Needle InsertionMethodFired or ManualManualSame as Mammotomerevolve U/S. Mammotomerevolve EX offers manualinsertion only.
Tip TypeBladed trocarBladed trocarSame
Tip MaterialStainless steelStainless steelSame
Needle ConfigurationDual lumenDual lumenSame
Needle MaterialStainless steelStainless steelSame
Needle Diameter Sizes8G and 10G8GSame as 8G (ST and U/S)
Vacuum PortAttachmentYes, tethered to ControlModuleYes, tethered to ControlModuleSame
Specimen Retrieval /Collection MethodAutomaticAutomaticSame
Housing MaterialPlasticPlasticSame
Cutting MethodRotation and translation of inner cutterRotation and translation of inner cutterSame
Tissue Transport MethodVacuumVacuumSame
Cutter MaterialStainless steelStainless steelSame
Packaging TypePETG with Tyvek CoverLDPE Pouch with Tyvek HeaderDifferent. The difference in packaging material does not raise new or different questions of safety or effectiveness. Sterilization and Shelf Life (Section 15) provides evidence of package integrity and the ability to maintain sterile barrier for this change in packaging type.
Sterilization MethodCobalt 60 IrradiationCobalt 60 IrradiationSame

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Image /page/7/Picture/4 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized blue symbol on the left, followed by the word "DEVICOR" in bold, with the first half in black and the second half in blue. Below "DEVICOR" are the words "MEDICAL PRODUCTS, INC." in a smaller, lighter font, also in blue. The logo is clean and professional, suggesting a company in the medical field.

Table 1b: Side-by-Side Comparison of Mammotome revolve EX Probes to previous Mammotome revolve ST and U/S Probes

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Image /page/8/Picture/3 description: The image shows the text "Page 6 of 9". The text is written in a simple, sans-serif font and is positioned in the top left corner of the image. The numbers indicate that this is page 6 of a document that has a total of 9 pages.

Image /page/8/Picture/4 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized hourglass shape in light blue on the left. To the right of the hourglass is the word "DEVICOR" in bold, with "MEDICAL PRODUCTS, INC." in smaller letters underneath.

The following Performance Data is provided in support of the substantial equivalence (SE) determination.

Summary of Non-Clinical Bench Performance Testing
Non-Clinical Bench Performance Testing was conducted on the Mammotome revolve EX System [subjectdevice]. The table below includes the list of the performance testing results submitted, referenced, or relied onin this premarket notification submission for a determination of substantial equivalence.
Sterilization and Shelf Life Testing
Sterility TestingTest Results: PASSED
FDA Recognized Testing Standards:The results of these Non-Clinical Bench Performance Data areprovided in support of the substantial equivalence determination.
o ISO 11137-1:2006/AMD 2:2018 -Sterilization of health care products– Radiation – Part 1: Requirementsfor development, validation androutine control of a sterilixationConclusion Supporting Substantial Equivalence: The results of theSterility Testing conducted on the Mammotome revolve EX Probesdemonstrates that the subject device is as safe, as effective, andperforms as well as, the legally marketed predicate device. This
οprocess for medical devicesISO 11137-2:2013 - Sterilization ofhealth care products – Radiation –Part 2: Establishing the sterilizationdosetesting supports a determination of substantial equivalence of theMammotome revolve EX System [subject device] when compared tothe Mammotome revolve Vacuum Assisted Biopsy (VAB) Systemdevice (K152989) [predicate device].
οANSI/AAMI/ISO TIR13004:2013-Sterilization of health care products— Radiation — Substantiation of aselected sterilization dose: MethodVDmax SD
Biocompatibility Testing
Biocompatibility Testing including:Test Results: PASSED
- CytotoxicityThe results of these Non-Clinical Bench Performance Data are
- Sensitizationprovided in support of the substantial equivalence determination.
- Irritation
- Acute Systemic ToxicityConclusion Supporting Substantial Equivalence: The results of theBiocompatibility Testing conducted on the Mammotome revolve EXProbes demonstrates that the subject device is as safe, as effective,and performs as well as, the legally marketed predicate device. Thistesting supports a determination of substantial equivalence of theMammotome revolve EX System [subject device] when compared tothe Mammotome revolve Vacuum Assisted Biopsy (VAB) Systemdevice (K152989) [predicate device].
- Material Mediated Pyrogenicity
FDA Recognized Testing Standards:
οISO 10993-1:2018-BiologicalEvaluation of Medical Devices –Part 1: Evaluation and TestingWithin a Risk Management Process
οISO 10993-5:2009-BiologicalEvaluation of Medical Devices –Part 5: Tests for In VitroCytotoxicity
οISO 10993-10:2010-BiologicalEvaluation of Medical Devices –Part 10: Tests for Irritation and SkinSensitization
οISO 10993-11:2017-BiologicalEvaluation of Medical Devices -Part 11: Tests for Systemic Toxicity
οISO 10993-12:2012-BiologicalEvaluation of Medical Devices –Part 12: Sample preparation andreference materials.
Software Verification and Validation Testing
Functional Testing including:- Software Unit Testing- System Integration Testing- Software Verification TestingTest Results: PASSEDThe results of these Non-Clinical Bench Performance Data areprovided in support of the substantial equivalence determination.Conclusion Supporting Substantial Equivalence: The results of theSoftware Testing conducted on the Mammotome revolve EX Systemdemonstrates that the subject device is as safe, as effective, andperforms as well as, the legally marketed predicate device. Thistesting supports a determination of substantial equivalence of theMammotome revolve EX System [subject device] when compared tothe Mammotome revolve Vacuum Assisted Biopsy (VAB) Systemdevice (K152989) [predicate device].
Electrical Safety and Electromagnetic Compatibilty (EMC) Testing
Functional Testing including:- Electrical Safety- Electromagnetic CompatibilityTest Results: PASSEDThe results of these Non-Clinical Bench Performance Data areprovided in support of the substantial equivalence determination.Conclusion Supporting Substantial Equivalence: The results of theElectrical Safety and Electromagnetic Compatibility (EMC) Testingconducted on the Mammotome revolve EX System demonstratesthat the subject device is as safe, as effective, and performs as wellas, the legally marketed predicate device. This testing supports adetermination of substantial equivalence of the Mammotomerevolve EX System [subject device] when compared to theMammotome revolve Vacuum Assisted Biopsy (VAB) System device(K152989) [predicate device].
FDA Recognized Testing Standards:○ IEC 60601-1:2005 + AMD1:2012 –Medical electrical equipment – Part1: General requirements for basicsafety and essential performance.○ IEC 60601-1-2:2014 - Medicalelectrical equipment - Part 1-2:General requirements for basicsafety and essential performance -Collateral Standard:Electromagnetic disturbances -Requirements and tests
Animal Lab Study
Tissue Sample Testing- Sample Weight- Sample Reliability- Sample QualityTest Results: PASSEDThe results of these Non-Clinical Bench Performance Data are provided in support of the substantial equivalence determination.Conclusion Supporting Substantial Equivalence: The results of the Animal Lab conducted on the Mammotome revolve EX System demonstrates that the subject device is as safe, as effective, and performs as well as, the legally marketed predicate device. This testing supports a determination of substantial equivalence of the Mammotome revolve EX System [subject device] when compared to the Mammotome revolve Vacuum Assisted Biopsy (VAB) System device (K152989) [predicate device].
FDA Recognized Testing Standards:Ο GPL regulation 21 CFR Part 58
Usability TestingTest Results: PASSEDThe results of these Non-Clinical Bench Performance Data were provided in support of the substantial equivalence determination.Conclusion Supporting Substantial Equivalence: The results of the Usability Testing conducted on the Mammotome revolve EX System demonstrates that the subject device is as safe, as effective, and performs as well as, the legally marketed predicate device. This testing supports a determination of substantial equivalence of the Mammotome revolve EX System [subject device] when compared to the the Mammotome revolve Vacuum Assisted Biopsy (VAB) System device (K152989) [predicate device].
Conclusion: The results of the Non-Clinical Performance Bench Testing support the safety of the device and demonstrate that the Mammotome revolve EX System (subject device) performs as intended in the specified use conditions and comparably in terms of safety, effectiveness, and performance to the Mammotome revolve Vacuum Assisted Biopsy (VAB) System device (K152989) [predicate device] which is currently marketed for the same intended use. Therefore, this Non-Clinical Performance Bench Testing supports a determination of substantial equivalence of the Mammotome revolve EX System [subject device] when compared to the predicate device

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Image /page/9/Picture/1 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized blue symbol on the left, followed by the word "DEVICOR" in bold, black letters. Below the word "DEVICOR" are the words "MEDICAL PRODUCTS, INC." in smaller, light blue letters. The logo is clean and professional, suggesting a company in the medical field.

K202012

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Image /page/10/Picture/1 description: The image shows the alphanumeric string 'K202012' in a simple, sans-serif font. The characters are evenly spaced and of uniform size. The text appears to be a code or identifier, possibly a serial number or product code.

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Image /page/10/Picture/4 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized symbol resembling two overlapping circles in light blue on the left. To the right of the symbol, the word "DEVICOR" is written in bold, dark brown letters. Below "DEVICOR", the words "MEDICAL PRODUCTS, INC." are written in a smaller, lighter font.

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Image /page/11/Picture/1 description: The image shows the logo for Devicor Medical Products, Inc. The logo features a stylized, light blue graphic element on the left, resembling two overlapping circles. To the right of this graphic is the word "DEVICOR" in bold, dark brown letters. Below "DEVICOR" are the words "MEDICAL PRODUCTS, INC." in a smaller, light blue font.

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K202012

Conclusion: The data generated from the results of the Non-Clinical Performance Bench Testing conducted on the Mammotome revolve EX System [subject device] demonstrate that the device is as safe, as effective, and performs as well as, the Mammotome revolve Vacuum Assisted Biopsy (VAB) System device (K152989) [predicate device]. Therefore, the data results may be relied on to support a determination of substantial equivalence.

§ 876.1075 Gastroenterology-urology biopsy instrument.

(a)
Identification. A gastroenterology-urology biopsy instrument is a device used to remove, by cutting or aspiration, a specimen of tissue for microscopic examination. This generic type of device includes the biopsy punch, gastrointestinal mechanical biopsy instrument, suction biopsy instrument, gastro-urology biopsy needle and needle set, and nonelectric biopsy forceps. This section does not apply to biopsy instruments that have specialized uses in other medical specialty areas and that are covered by classification regulations in other parts of the device classification regulations.(b)
Classification. (1) Class II (performance standards).(2) Class I for the biopsy forceps cover and the non-electric biopsy forceps. The devices subject to this paragraph (b)(2) are exempt from the premarket notification procedures in subpart E of part 807 of this chapter subject to the limitations in § 876.9.