A nuclear medicine guided system and method for stereotaxic localization of breast carcinoma lesion sites, used in conjunction with a nuclear medicine detection device, of a patient who has been injected with a radioactive substance which preferentially accumulates in carcinoma lesion sites. The system includes a table, a pair of fenestrated paddles, and a guide means. The table has a top surface, upon which the patient lies in a prone position, and at least one opening through which the patient's breast being examined will pendulously protrude therethrough. A pair of fenestrated paddles are positioned under the bottom surface of the table in the vicinity of the opening, and are moveable relative to each other to compress the patient's breast therebetween. The guide is positioned under the table in the vicinity of the opening. The guide has plurality of moveable sighting guides, each moveable along one of three orthogonal axes, and each sighting guide having a radioactive sighting line located thereon. The moveable sighting guides are moved to line up with the lesion site, as detected by the nuclear medicine detector device, to localize the carcinoma lesion sites in three dimensions and in real-time.