Ultrasound guided needle biopsy is an important method for collection of breast cancer tissue. In this paper, we report on the design and testing of a high-voltage 1 to 64 Multiplexer/Demultiplexer (MUX/De-MUX) integrated circuit (IC) for ultrasound-guided breast biopsy applications implemented in a high-voltage CMOS process. The IC is intended to be incorporated inside the breast biopsy needle and is designed to fit inside the needle inner diameter of 2.38 mm. The MUX/De-MUX electronics are made up of three parts, including a low-voltage 6 to 64 decoder, a level shifter to convert from low voltage to high voltage, and analog high-voltage switches. Experimental results show a -3-dB bandwidth of over 70 MHz, Rds (on) of , -2.279-dB insertion loss, and -17.5-dB off isolation at 70 MHz with low-voltage input. Finally, we present results obtained via synthetic aperture imaging using the fabricated MUX/De-Mux device and a high-frequency ultrasound array. This device and technique hold promise for high-frequency imaging probes where a limited number of elements are used and the depth of penetration is short such as in breast biopsy and intravascular applications.