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Objectives: Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of ovarian lumps is being increasingly used for the successful diagnosis of ovarian mass lesions and it is a rapid, accurate, economical, and safe procedure to diagnose various ovarian mass lesions. The aims of the study were to categorize and study the cytomorphological features of the ovarian mass lesions, study the age distribution and analyzing cytological features of the ovarian mass lesions, and to evaluate the sensitivity, specificity, and diagnostic accuracy of USG-guided FNAC in diagnosing ovarian mass lesions. Methods: A prospective observational study of 24 patients with clinically and radiologically diagnosed ovarian mass lesions and referred for FNAC in Department of Pathology of a tertiary care hospital. USG-guided FNAC was performed in each patient and cytological features were analyzed. Results: In our study, out of total 24 USG-guided FNAC of ovarian lesions, ovarian malignancies were most common – 11 cases (45.83%), followed by benign ovarian tumors – ten cases (41.66%), inflammatory lesion – one case (4.16%), and two cases (8.33%) were unsatisfactory smears. In our study, diagnostic accuracy of USG-guided FNAC was found to be 91.66%. Conclusion: USG-guided FNAC is a simple, safe, quick, reliable, efficient, and easily available diagnostic procedure and with less number of complications that it has a very important role in accurate diagnosis of ovarian mass lesions. It is a safer alternative to the more expensive and time consuming surgical procedure like diagnostic laparotomy.