Fine needle aspiration cytology (FNAC) is a minimally invasive and cost effective technique. However some of the deep seated lesions may have occult carcinomas which could be missed on conventional FNAC of a multinodular goitre or non__ampersandsignndash;palpable nodules. Ultrasound guidance is helpful in directing the needle to solid portions of the cystic or mixed nodules and reduce the need for repeat FNAs but adds to cost and turn-around time of patient. Objectives: The study was conducted to compare the results of conventional FNAC with Ultrasound (USG)-guided FNAC and correlate with histopathology to evaluate the sensitivity, specificity and diagnostic accuracy of both types of FNAC. Materials and Methods: The study was conducted on 140 patients who underwent conventional FNAC in the department of Pathology and subsequently USG-guided FNAC in department of Radiology. Smears were prepared from both the FNA and were reported separately by the same pathologist. Statistical Indices used in the present study for both conventional and USG-guided FNAC with histopathology as gold standard are Sensitivity, specificity, and diagnostic accuracy. Comparison of the FNAC results with histopathology showed that there were five false negative results in conventional FNAC and two false negative results in USG-guided FNAC. Results: The sensitivity and diagnostic accuracy were 77.8%, 92.9% on USG-guided FNAC and 44.4%, 82.1% on conventional FNAC. In conclusion, USG-guided FNAC improved the cytological diagnostic accuracy, sensitivity and reduced the false-negative rates in comparison to conventional FNAC especially in case of multinodular goitre.