Abstract MRI-guided breast biopsy techniques were developed to sample indeterminate and suspicious breast lesions visible only on MRI. Breast MRI performed for high-risk screening, problem solving, or assessment of extent of disease in patients with newly diagnosed breast cancer may demonstrate indeterminate findings, such as enhancing foci, masses or non-mass enhancement. If the lesion is not visible by mammography or ultrasound, and MRI follow-up is not appropriate, then MRI-guided biopsy is indicated. This chapter, appearing in the section on interventions and surgical changes, reviews the key points and procedural protocols and pitfalls for performance of magnetic resonance imaging (MRI)–guided breast core biopsy. Pre-, peri-, and post-procedure clinical management, radiology–pathology correlation, and imaging follow-up are also reviewed.