Cytology of breast secretions, fine needle aspiration cytology (FNA) of the breast and core biopsy of the breast have been used for a long time. However, the application of the different approaches and their benefit for patients is still discussed. While FNA has challenged surgical biopsy since many years, additionally, core biopsy gets more important due to simplification of handling and decreasing tissue trauma. In conjunction with imaging techniques the number of necessary surgical biopsies has dramatically decreased in many places. Characteristics of the two approaches are tabulated in this contribution, which focuses on symptomatic patients presenting with either lumps of the breast or mammary secretions. Cytologic examination of breast secretions allows early diagnosis of intraductal carcinoma in situ and invasive ductal carcinoma in about 1% of all breast secretions. Careful localisation of the lesions is necessary. Most cases of breast cancer do not cause secretions, so, breast secretion cytology will contribute only in a minority of cases. In cases showing both, breast secretion and lumps, these should be considered as possibly caused by different lesions.