Introduction: Image guided fine needle aspiration biopsy of retroperitoneal masses is an increasingly common diagnostic procedure in oncology (Porter, 1981). It has a brought a revolution in the field of cytopathological diagnosis of a less accessible site like retroperitoneum. Aims and Objectives: The aim of our study was to assess efficiency of image guided FNAC in pre-operative diagnosis and management of retroperitoneal lesions. Material and Methods: The study was conducted over a period of three years from june 2014 to june 2017. It included analysis of 108 patients who presented clinically and radiologically with retroperitoneal lesions. Results: Out of the total 108 retroperitoneal lesions studied with majority of the patients belonging to the age group of 51-60 years (39.13%).The study revealed a male predominance (58.3%). The malignant lesions predominated and constituted a total of 61(56.4%) cases. Majority of the cases were from the pancreas (62.9%) followed by kidney (23.2%). Among the pancreatic lesions adenocarcinoma (63.9%) was the most common tumor. RCC constituting 47.4% of the renal lesions was the most common. Among the retroperitoneal lymph nodes also metastatic adenocarcinoma (40%) was the most common lesion. Histopathological correlation could be done in 38 cases and all 38 cases were compatible with the cytological diagnosis. Conclusion: The study revealed that image guided FNAC is an excellent diagnostic modality and shows high accuracy and high sensitivity in diagnosing retroperitoneal lesions with minimal complications
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