Fine-needle aspiration (FNA) cytology is widely accepted as the initial diagnostic tool of choice in the evaluation of thyroid and salivary gland tumors. FNA, however, has some limitations which have recently led a few investigators to advocate the use of core needle biopsy (CNB) as an alternative to FNA. The development of fine-gauge, single-action, spring-loaded biopsy needles has greatly facilitated image-guided biopsy of head and neck lesions. These modern CNBs, under ultrasound guidance, may be helpful in cases where FNA diagnosis has been initially rendered “unsatisfactory” or found to be discrepant with the clinical findings. Although in recent literature CNB appears to be well tolerated and has a low incidence of complications, it is still not commonly used in the routine assessment of thyroid and salivary gland lesions. FNA is likely to, and should, remain as the screening tool of choice in assessing these lesions. Ultrasound-guided CNB should not be seen as a competitor to FNA but rather as a complementary investigational tool.