Because appropriate clinical management is guided by the nature of the mass, accurate diagnosis of discrete hepatic masses is very important. Possible treatments range from supportive care for advanced metastatic lesions to partial hepatectomy for primary carcinomas. Despite recent improvement, radiological imaging does not always allow precise characterization of the lesions. Serological markers (such as alpha fetoprotein) can be useful in narrowing the differential diagnosis when they are markedly elevated but a substantial number of patients unfortunately do not have high levels of these markers at the time of presentation. Therefore, a tissue diagnosis is often required to guide subsequent management. Fine needle aspiration biopsy (FNA) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneously or endoscopically. This review will discuss fine needle aspiration biopsy of liver from a pathologist's perspective. The review will also address the cytology and the pitfalls of some of the more commonly encountered hepatic lesions as well as those that may pose diagnostic challenges. Currently, there are several diagnostic procedures to obtain preoperative tissue diagnosis to guide subsequent therapy. They include image guided fine needle aspiration biopsy, blind percutaneous needle core biopsy, and transjugular needle core biopsy. Percutaneous needle core biopsy without imaging guidance is excellent for diagnosing diffuse liver diseases such as hepatitis, cirrhosis, and metabolic diseases. Accuracy is superb and the complication rate is low. However, it is not indicated for focal, discrete hepatic lesions. To minimize the risk of hemorrhage, transjugular approach is often reserved for patients with a bleeding diathesis. Fine needle aspiration biopsy (FNA) under image guidance has gained increasing acceptance as the diagnostic procedure of choice for patients with focal hepatic lesions. It can be performed percutaneously or endoscopically. The latter approach is technically difficult for lesions located far away from the tip of the echoenodoscope and lesion near the 2nd or 3rd portion of the duodenum because of poor visualization [1]. FNA may also be performed at laparoscopy or laparotomy under direct vision when imaged guided FNA fails to provide diagnostic tissue [2]. This review is not intended to be exhaustive. Therefore, the discussion is limited to the lesions that are more commonly encountered in day-to-day practice and those that may pose diagnostic challenges.