A guiding attachment is described that transforms a conventional magnetic resonance (MR) imaging surface coil into a stereotaxic biopsy unit. Eight patients, aged 38-66 years (mean, 54 years), with suspect breast lesions detected exclusively at contrast material-enhanced MR imaging underwent MR-guided needle biopsy with this unit. Diagnostic material was successfully aspirated in all patients (four carcinomas, three fibroadenomas, and one intraductal hyperplasia), and the diagnosis was subsequently confirmed at surgical biopsy. This technique promises to increase the diagnostic specificity for lesions seen solely at MR imaging.