Background: Due to increasing trend of gallbladder carcinoma in India, early diagnosis of gallbladder lesion has become essential. Ultrasound guided fine needle aspiration (FNAC) has emerged as an effective diagnostic tool for precise diagnosis of deep seated lesion. Aim: It is to determine the accuracy of ultrasound guided fine needle aspiration cytology and its histopathological correlation. Materials and Methods: This retrospective study for a span of 3 years (April 2017 – March 2020 ) in department of pathology and radiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. Ultrasound guided fine needle aspiration cytology of gall bladder and their histopathological findings were compared. Results: The study included 76 cases and lesions were categorized on FNAC into inadequate, benign,suspicious of carcinoma, carcinoma gallbladder (most common in present study) and metastatic carcinoma. The most common pattern FNAC of neoplasm was sheets and acini with predominance of columnar cell and adenocarcinoma being the most common malignancy. The histopathological diagnosis was available in 65 cases and sensitivity of ultrasound guided FNAC was 98.3% in malignant cases Conclusion: Image guided FNAC plays an important role in diagnosis of gallbladder lesions with minimal complications. In addition to early confirmation and pre–operative diagnosis of malignancy, it allows for morphologic evaluation according to WHO classification, which is necessary for prognostication of the disease