Objective: The present study was undertaken to evaluate the diagnostic efficacy of image guided percutaneous fine needle aspiration cytology- FNAC in various lung lesions - both neoplastic and non-neoplastic.

Material and Method: Over a period of one year, computerized tomography (CT)–guided FNAC was performed in forty patients presenting with respiratory symptoms with a localized lung lesion clinically, which was confirmed radiologically.

Results: Male preponderance was noted in this study with M:F ratio of 2.08:1. Malignancy was the predominant lesion found in this study with twenty-four cases (60%). Among the malignant lesions, adenocarcinoma was the commonest malignancy followed by squamous cell carcinoma. Material in two cases was inadequate for interpretation. Adenocarcinoma was the commonest malignancy seen in females. However, adenocarcinoma was still more common in males overall. Squamous cell carcinoma was the commonest malignancy seen in males. Squamous cell carcinoma was the commonest malignancy among smokers. The diagnostic accuracy was 95% considering cytological criteria as the standard.

Conclusion: Transthoracic CT-guided FNAC is a relatively safe and accurate procedure in the diagnosis of difficult lung lesions. FNAC should be used earlier and more frequently to shorten the diagnostic interval and allow more prompt therapy for persistent lung lesions.