Image-guided biopsy is well established in clinical practice, however a recent shift towards "personalized medicine" and genomic research, particularly in the oncology setting, has resulted in a greater demand for tissue, not only at preliminary diagnosis but at multiple time points in the patient's journey. Research into the molecular pathobiology underpinning cancer development and progression continues to identify diagnostic, predictive and prognostic biomarkers that help determine and guide treatment both at the outset, and as patient's progress or recur. This extensive tissue analysis however, necessitates larger tissue cores and a greater number of biopsies with correct fixation of the specimens obtained. We discuss the impact that this shift towards genomic medicine has taken on both radiologists and histopathologists and stress the importance of correct specimen preparation as well as biopsy technique to maximize diagnostic yield, by reviewing different methods of specimen fixation that are now required in clinical practice dependent on the clinical question posed.