ABSTRACT Aims: This prospective study was carried out to compare findings of the four procedures namely FNAC (fine-needle aspiration cytology), USG (ultrasonography), US-FNAC (Ultrasound-guided fine-needle aspiration cytology), and HPE (histopathological examination). MATERIAL AND METHODS Total 80 cases of different neck swellings were selected from ENT OPD at tertiary care hospital Prayagraj Uttar Pradesh. All cases underwent the preoperative procedure of FNAC,USG, US-FNAC and postoperative HPE for diagnosing the neck swelling. The results of FNAC, USG, US-FNAC w e r e c o m p a r e d a n d c o r r e l a t e d w i t h histopathology findings and conclusions drawn after statistical analysis. RESULTS More than half (56.25%) of neck swellings were of thyroid swellings. It was observed that sensitivity, specificity, PPV, NPV, accuracy of FNAC of all neck swellings were 85.71%, 91.78% ,50%, 98.53% ,91.25% respectively. Sensitivity ,specificity, PPV ,NPV , accuracy of all neck swellings of USG were 71.43%, 98.63%, 83.33% , 97.26% 96.25 respectively. Sensitivity ,specificity, PPV ,NPV , accuracy of all neck swellings of US-FNAC were 85.71% ,97.26% ,75% , 98.61%, 96.25 respectively. CONCLUSION The combined use of USG and FNAC give more accuracy for proper diagnosis of neck swelling than FNAC alone. The most accurate diagnosis of