INTRODUCTIONFine Needle Aspiration technique was described for the first time by Greig and Gray in 1904. Since the mid-1960's, it has been increasingly used and a high degree of accuracy has been achieved.l Lymphadenopathy is one of the commonest presenting symptoms of all age groups attending out door. The etiology can vary from simple inflammatory reactive lesion to a malignant condition.Therefore lymphadenopathy requires further evaluation. FNAC has been a suitable investigation to rule out malignancies and to confirm reactive or infective pathology.2,3 The use of fine needle aspiration cytology (FNAC) in the investigation of lymphadenopathy has become an acceptable and widely practiced minimally invasive technique, which is safe, relatively painless, simple and rapid. FNAC is highly cost effective and accurate as a first line investigative technique. With the recent advances in ultrasound and CT scan technologies, focal lesions can be aspirated using this procedures. 4 Fine needle aspiration cytology (FNAC) has emerged as an advanced diagnostic tool to differentiate reactive hyperplasia/inflammatory conditions, granulomatous disorders and lymphomas. This diagnostic modality has gained considerable importance in the management of patients with lymphadenopathy over several years. We are reporting histopathological correlation of 200 cases of lymphadenopathy with FNAC. ABSTRACTBackground: Lymphadenopathy is very common presenting symptoms. Fine needle aspiration cytology (FNAC) is used to evaluate the nature of the lesion. Etiology of lymphadenopathy in head and neck region vary from benign reactive hyperplasia to tubercular granulomatous lesion to malignancy. The aim of present study was to evaluate the sensitivity, specificity and predictive value in tuberculosis and metastatic carcinoma. Methods: A total of 80 patients out of 200 patients who underwent FNAC were evaluated by histopathological examination for correlation. Aspiration smears and histopathological slides were evaluated and results were calculated for sensitivity, specificity and predictive value. Results: Reactive lymphadenitis was seen in 40 patients followed by tubercular granulomatous lymphadenitis in 20 patients and malignant lesions in 20 patients. Histology revealed 18 patients of tubercular lymphadenitis, 43 of reactive changes, 12 of metastasis in lymph nodes and 7 of lymphomas. Correlating the findings, we could achieve 100% sensitivity and 96.7% specificity for tubercular lymphadenopathy and for metastatic it was 98.5% and 100% respectively. Conclusions: We have found FNAC a satisfactory tool in the diagnosis of tubercular and malignant lymphadenopathy. FNAC used in conjunction with clinical findings, radiological and laboratory investigations can be a cost effective method for the diagnosis of lymphadenopathy.