Ultrasound-guided fine needle aspiration cytology (USFNAC) when applied as initial investigation often proves non-diagnostic, the incidence being as high as 50% in a recent audit. In this study, the authors applied ultrasound-guided core biopsy (USCB) to neck lumps over 1cm as first-line investigative modality, and accurately diagnosed 271 cases (94.4%) in the first attempt. This high pick-up rate included metastatic squamous cell carcinoma in 60% and lymphoma in 31%of cervical node lumps. Pleomorphic adenoma and Warthin’s cyst, along with some malignant lesions, were picked up in salivary gland lumps. Lipoma and branchial cyst were the commonest diagnosis in non-nodal neck lumps and submandibular gland biopsies diagnosed pleomorphic adenoma, sialadenitis and lipoma. The authors contend that apart from being readily diagnostic, USCB saves the need for excisional biopsy which is unacceptable in cases of squamous cell carcinoma. Tumour implantation can occur but this was not a complication in this series, and the benefits of USCB outweighed this small theoretical risk. However, 50% of repeat USCB proved non-diagnostic and excisional biopsy is recommended in such instances. The study seems highly relevant where time is an important factor in the diagnosis of malignancy.