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Background: Since the introduction of fine needle aspiration cytology (FNAC), the diagnostic approach to palpable breast lumps has been significantly improved. FNAC is a minimally invasive, rapid, and cost-effective technique with high sensitivity and specificity, and it remains an integral component of triple assessment for breast lesion diagnosis. Objective: This study aims to analyse the cytological spectrum of palpable breast lumps diagnosed by FNAC and to evaluate its diagnostic accuracy in differentiating benign and malignant breast lesions through histopathological correlation. Materials and Methods: A two-year prospective study was conducted at our institution, during which 490 FNAC procedures (including six bilateral cases) were performed on patients presenting with palpable breast lumps. Suppurative and inflammatory lesions were excluded. Cytological diagnoses were categorized as benign, suspicious and malignant. Among these cases, 94 patients subsequently underwent mastectomy or open/excision biopsy, and FNAC findings were correlated with histopathological diagnoses. Diagnostic performance parameters of FNAC were calculated using histopathology as the gold standard. Results: Of the 490 FNAC cases, 373 were reported as benign, 4 as suspicious for carcinoma, and 113 as carcinoma. The majority of patients were premenopausal women, with the most common age group being 31–40 years. Histopathological follow-up was available in 94 cases. FNAC demonstrated an accuracy of 100% for benign lesions and 92.10% for malignant lesions, with a false-negative rate of 7.90% and no false-positive results. The overall sensitivity, specificity, positive predictive value, and negative predictive value of FNAC in diagnosing palpable breast lumps were 92.10%, 100%, 100%, and 94.91%, respectively. Conclusion: FNAC, when performed by experienced hands, is a highly reliable diagnostic tool for palpable breast lumps, characterised by very high specificity and an extremely low false-positive rate. Its sensitivity can be further enhanced through appropriate clinical and imaging correlation. Despite evolving diagnostic modalities, FNAC continues to play a vital role in the systematic evaluation and management of breast lumps, particularly within a multidisciplinary diagnostic framework.