Objective: The aim of the study was to compare the accuracy of fine-needle aspiration cytology (FNAC) over open biopsy in the assessment of the cause of neck swellings. Methods: The sample includes 100 patients with neck swellings who visited the nose and throat outpatient department at M.G.M. Medical College and Lions Seva Kendra Hospital in Kishanganj, Bihar. The period of study was 2 years, from October 2019 to October 2021 prospective study. All cases of neck enlargement were referred for radiological examinations. A ultrasound neck Doppler study was performed to determine the nature and vascularity of the swelling. Then, all the cases of neck swelling were sent to the department of pathology for FNAC. Results: Lymph node aspiration was carried on in 25 cases, tubercular lymphadenitis, which was the commonest swelling in our study. Twenty-five of these lymph node cytology reports were similar to the histopathological examination (HPE) report. Of the 49 thyroid swelling aspirates, 24 cytological reports were similar to HPE reports, and 20 reports did not match with HPE reports. Two cases of colloid goiter were found to be papillary carcinoma of the thyroid. Out of eight salivary gland swelling were matched with the HPE reports. One more case of lateral neck swelling was noted in FNAC as adnexal mass. The patient underwent surgery histopathology concluded as schwannoma. Conclusion: FNAC of neck masses with clinical correlation can provide the surgeon with the most helpful information to determine the different management modes. It is also essential to take into consideration clinical symptoms and biochemical tests. Hence, we conclude that FNAC is a safe, simple, and rapid method that can be done to diagnose a wide range of neck swellings.