Fine-needle aspiration biopsy (FNA) is a cost-effective and clinically reliable tool in the management of palpable solid breast lesions. Review of 369 FNA biopsy specimens revealed an accuracy of 92%. The sensitivity was 78% and the specificity was 100%. There were no false-positive results. Positive predictive value was 100%, and negative predictive value was 78%. A positive FNA biopsy result, which confirms a clinical (physical examination and mammography) impression of carcinoma, can be the basis for planning and performing a definitive procedure. Despite the absence of false-positive results, we have not proceeded with a definitive surgical procedure if an FNA biopsy result disagreed with our clinical impression. Fine-needle aspiration biopsy may be used to reassure and support both the patient's and the surgeon's decision not to perform a biopsy of "subsuspicious lesions." A negative FNA biopsy result does not exonerate the clinically suspicious lesion.