Breast carcinoma is one the most common malignancies worldwide and the leading cause of death in females. It usually appears as a lump in the breast. There are many diagnostic modalities used in the diagnosis of this disease and cytological examination of fine needle aspirates (FNAC) has become a widely used preoperative diagnostic technique in the management of any breast lump (1).Fine-needle aspiration cytology is a safe procedure in the adjuvant diagnosis of breast lumps in clinical settings (2). The three main areas where FNAC plays a major role in breast diseases are the following: (a) the diagnosis of benign disease in symptomatic palpable lumps as part of triple assessment; (b) the staging of breast carcinoma, in particular preoperative axillary lymph node FNAC and intraoperative sentinel node imprints; and (c) the diagnosis of metastatic disease at distant sites following treatment for carcinoma (3).Fine-needle aspiration cytology of breast lumps is a sensitive, specific and accurate method for grading these lesions into cytologic evaluation system (C1-C5) as practiced in the National Breast Screening Program in the UK (4) and worldwide.The triple test score which includes physical examination, mammography, and fine-needle aspiration cytology, is the most popular score to evaluate patients with palpable breast lumps. It is not only increases the reliability of clinicians but also increases the sensitivity and specificity of the diagnostic evaluation and detects patients with breast cancer with an overall greater accuracy (5,6).This was a retrospective review of 167 patients. All breast cancer patients were operated on by the first author in different hospitals in Bahrain both government run and privately owned. One hundred and sixty two breast cancer patients were reviewed from January 2000 to May 2012.All of these patients had tripled testing (physical examination, radiological imaging and fine-needle aspiration cytology) as part of their diagnostic assessment. FNAC results were compared to the provisional clinical assessment, and mammography beside histopathology.The FNAC results were divided into five groups, according to the report, from C1 to C5. C1 results were inadequate samples. C2 and C3 results were benign and likely benign. C4 and C5 were the malignant results. After thorough examination of the smears, the cases were grouped into five major diagnostic classes (7).All cases suspicious for malignancy on mammography and clinical evacuations were proceeded to FNAC and tru-cut biopsies. Of 162 study cases, there were 4 cases of C1, 6 cases of C2, 4 cases of C3, 27 cases of C4, and 121 cases of C5 on FNAC.Ten cases were misdiagnosed as C2 and C3 but with help of tru-cut biopsies two cases were diagnosed as malignant, while eight cases were assessed with the help of mammography and clinical evaluation.The breast carcinoma was diagnosed with help of triple testing; only one case was false negative on clinical assessment while no false-negative cases were seen on mammography.Clinical assessment when com...