We describe the technique of ultrasound-guided core biopsy with a spring-loaded device in 54 patients who presented with palpable lesions of the parotid gland. Biopsy provided a sample suitable for histological analysis in all patients and was done quickly and safely under local anaesthesia. Initial diagnostic ultrasound confirmed the presence of focal palpable lesions and identified additional impalpable lesions in seven patients. Core biopsy was 100% accurate in differentiating benign from malignant disease. The diagnosis was accurate in 27 of the 28 patients who were subsequently operated on. Twenty-six patients avoided an unnecessary operation. The technique is also useful in patients with diffuse enlargement of the parotid gland and provides a core of tissue for accurate assessment of tissue architecture.