BACKGROUND: FNAC is a simple, cost effective, readily repeated and quick to perform procedure, with excellent patient compliance. It is, however, not without limitations related to specimen adequacy, sampling techniques, and overlapping cytological features between benign and malignant follicular neoplasm. Here arises the need for Histopathological examination (HPE), as it is considered the final diagnostic test. OBJECTIVE: This study aims at correlating the cytological diagnosis with the final histopathological diagnosis to evaluate the sensitivity, specificity and positive predictive value of smears and thereby its role in the preoperative diagnosis of thyroid swellings. METHODS: Data for the study was collected from patients undergoing thyroidectomy in Department of ENT, Head and Neck Surgery at Raja Rajeswari Medical College and Hospital, Bangalore. The study period was from 1 st October 2013 -30 th September 2014. Fine needle aspiration cytology of the swelling was done on OPD basis for all patients presenting with goitre. Thyroidectomy specimens preserved in 10% formalin was sent for histopathology examination. RESULTS: A total of 157 patients was evaluated, out of which 118 patients underwent FNAC. 15 were unsatisfactory aspirates. A total of 57 cases were operated specimens were available for histopathologic examination. The mean age of patients were 36.9 years. The ratio between female to males was 7.1:1. The sensitivity of FNAC was 87.5%, the Specificity was 100%, accuracy was 98.2%, and the positive predictive value of a positive test for malignancy was 100%. CONCLUSION: FNAC of thyroid lesions has been shown to be safe, simple, cost effective and accurate method for management of palpable thyroid lesions. It not only facilitates the communication among cytopathologists, surgeons, radiologists, and endocrinologists but also facilitate research into the epidemiology, molecular biology, pathology and diagnosis of thyroid diseases.