BACKGROUND: Stereotactic localization and breast biopsy by fine needle and 14-gauge core needle is a new technique for diagnosing nonpalpable breast lesions. The procedure employs a device that affords extremely accurate localization and sampling of nonpalpable breast abnormalities. METHODS: We are a 5-man surgical group reporting on the experience of our initial 300 consecutive stereotactic core-needle biopsies (SCNB). RESULTS: The procedures, conducted over a 13-month period, revealed 31 cancers, for a malignancy rate of 12%, Seven percent were infiltrating ductal carcinoma and 4% ductal carcinoma in situ. There were 2 cases of adenocarcinoma, and 1 case of mucinous carcinoma. Benign microscopic diagnoses included 193 categorized as ''fibrocystic change,'' 34 ''fibroadenomas,'' 19 ''benign breast tissue,'' and 5 lesions that were suspected of being malignant but were proven to be benign. There were 12 ''others.'' CONCLUSION: We conclude that SCNB is an essentially painless, short outpatient procedure with a reduced cost compared to open biopsy. It can be easily mastered by surgeons. Results are comparable to controlled series in the literature, and rates of malignant diagnosis are similar to our group's experience in previous years.