BACKGROUND Lymphadenopathy is a frequent problem encountered in clinical practice with majority of the cases self-limiting. However, it can be due to malignant diseases like lymphoproliferative diseases and metastatic lesions, hence an early diagnosis of its aetiology is essential for its management. Fine needle aspiration (FNA) of lymph node is a simple procedure that can be performed in outpatient clinic and FNA cytology provides early diagnosis. Aim-To categorise the various causes of lymphadenopathy and assess the efficiency of FNAC as a dependable, cost effective, efficacious diagnostic method in lymph node lesions. MATERIALS AND METHODS This IRB approved prospective study was carried out in a tertiary care teaching centre. Lymph node FNAC diagnoses of 70 patients were correlated with the histopathological diagnosis, which is considered as the gold standard. RESULTS Lymphadenopathy due to non-neoplastic diseases (55.7%) outnumbered the neoplastic diseases (44.3%). Nonspecific reactive lymphadenopathy was the most common lymph node pathology (31.4%) followed by metastatic lymphadenopathy (22.9%). Acid fast bacilli were demonstrated by Auramine-rhodamine staining in all cases of suppurative granulomatous lymphadenitis. Discussion-Diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of FNAC to diagnose nonspecific reactive lymphadenopathy were 100%, 95.8%, 91.6%, 100%, and 97.1% respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and efficiency of FNAC were 100% in case of chronic granulomatous lymphadenitis, suppurative granulomatous lymphadenitis, suppurative lymphadenitis, fungal lymphadenitis, and Hodgkin lymphoma. The overall diagnostic efficiency of FNAC in this study was 97% (68/70) and the overall discordance rate was 3% (2/70). CONCLUSION FNAC is an effective, inexpensive, rapid and simple tool which renders a prompt diagnosis for the management of patients with lymphadenopathy and surgical excision biopsy can be avoided in a good number of cases. Use of ancillary staining studies in FNA smears improves the accuracy of this diagnostic tool.