Background: Fine needle aspiration cytology (FNAC) is a wellâestablished diagnostic technique in adult mass lesions but a comparatively new technique to pediatric lesions. Aim: The current study aims to evaluate the role of FNAC in pediatric age with special reference to pediatric tumors. Subjects and Methods: A retrospective study of FNAC in children ≤ 18 years of age presenting with mass lesions was studied for 5 years. Distribution of cases in different age groups, sex, and site of lesion was analyzed. Pediatric lesions were categorized into nonâneoplastic, benign, and malignant conditions. Diagnostic efficacy was assessed by comparing subsequent histopathological examination wherever possible. Statistical Analysis: Epi info 07 (Centers for Disease Control and Prevention in Atlanta, Georgia (USA) 07) and values were presented as simple percentages. Results: FNAC was performed on 2903 cases in 5 years out of which 327 cases 11.3% (327/2903) were ≤ 18 years of age. Out of 327 cases, 180 cases 55% (180/327) were between 11 and 18 years. Male to female ratio was 1.15:1. The commonest site for FNAC was cervical lymph node swelling 48.3% (158/327). Reactive lymphadenitis was the commonest diagnosis among all mass lesions 38.8% (103/265), whereas Fibroadenoma 20.8% (10/49) was commonest diagnosis among benign lesions and among malignant lesions there were two cases 15.3% (2/13) each of Hodgkins and nonâHodgkins lymphoma and one case of chondrosarcoma. The positive predictive value of diagnosing malignant lesions on FNAC was 100%. Conclusions: The ease of FNAC along with its high diagnostic accuracy makes it a desirable method for diagnosing lesions in children.