Background: Breast lesions encompass a broad spectrum of inflammatory, benign, atypical, and malignant conditions. Fine-needle aspiration cytology (FNAC) has become an indispensable diagnostic tool because of its rapidity, safety, affordability, and high diagnostic accuracy. Evaluating the cytological spectrum of breast lesions over an extended period provides valuable epidemiological information and assists clinicians in optimizing patient management.

Objective: To evaluate the cytological spectrum of breast lesions diagnosed by FNAC over five years in a tertiary care institution and analyze their clinicopathological characteristics.

Materials and Methods: This retrospective observational study included 1,032 patients presenting with palpable breast lesions between January 2020 and December 2024. FNAC smears were stained with May-Grünwald-Giemsa and Papanicolaou stains. Lesions were categorized according to cytomorphological diagnosis and correlated with age, sex, and lesion distribution.

Results: Among 1,032 cases, benign lesions constituted 63.8%, malignant lesions 28.7%, inflammatory lesions 6.2%, and atypical/suspicious lesions 1.3%. Fibroadenoma was the commonest benign lesion (39.5%), while invasive ductal carcinoma represented the predominant malignant diagnosis (84.8%). Benign lesions predominated in women aged 21–40 years, whereas malignant lesions were common after 45 years.

Conclusion: FNAC remains an excellent first-line diagnostic modality for breast lesions. The predominance of benign lesions highlights the importance of cytology in preventing unnecessary surgical intervention while ensuring early identification of malignant disease. Standardized reporting systems further improve diagnostic reproducibility and communication. (J Pathology Transl Med)