Since the widespread use of core needle biopsies (CNBs) for diagnosing breast lesions, fine-needle aspiration (FNA) biopsy is dramatically decreasing. Contributing factors to the decrease in FNA of breast masses include FNA's inability to separate atypical ductal hyperplasia (ADH) from ductal carcinoma in situ (DCIS) and DCIS from the invasive carcinoma, which has patient management implications. However, CNB also has some inherent limitations due to its occasional inability to make a definitive diagnosis for a number of breast lesions and discordance between ancillary studies performed on CNB versus the resected specimen results. CNB has now become the standard of care in the United States for evaluation of nonpalpable breast lesions. For palpable lesions, FNA appears currently to have the most value as completing the “triple test” for a negative diagnosis and confirming the diagnosis of locally advanced and/or inoperable carcinoma, locally recurrent breast cancer, and metastatic disease. FNA in the hands of experienced cytologists still has an important role in the diagnosis of primary palpable breast cancers. Familiarity and understanding the advantages and limitations of each biopsy technique will help select the most appropriate procedure for the workup of the patient with a breast mass.