Purpose: The research aimed to evaluate FNAC diagnostic adequacy and clinical concordance, failure rates, and cost-effectiveness at a high-volume oncology imaging department in a low-resource setting and determine its role as an initial diagnostic tool during the evolving oncologic care era.

Materials and Methods: A five-year retrospective study analyzed FNAC procedures from January 2019 through December 2023 within a newly built oncology radiology unit in a developing country. Data from radiology departments, combined with pathology records and clinical follow-up documentation, were reviewed. The evaluation included measures for sample adequacy, diagnostic accuracy, imaging, clinical suspicion concordance, Tru-Cut biopsy escalation rates, procedural expenses, and operational feasibility assessments. System capacity under pressure was evaluated by studying the number of staff members and the daily patient volume.

Results: The FNAC procedures involved 412 examinations that analyzed organs such as breast tissue, thyroid glands, lymph nodes, abdominal regions, and soft tissue areas. Sample inadequacy occurred in only  1.2% of cases (n=5), while 94.4% of samples matched clinical and imaging assessments. The diagnostic accuracy of the tests reached 93.9%. Tru-cut biopsy required sampling again for 3.6% (n=15) of cases, while the number of cases with altered diagnosis remained extremely low. The application of FNAC resulted in substantial cost reduction relative to Tru-Cut biopsy procedures and allowed physicians to make swift diagnostic and treatment choices. The study demonstrated FNAC's operational sustainability and high diagnostic reliability in a newly developed ,high-demand oncology setting.

Conclusion: FNAC has established itself as an effective and affordable diagnostic tool that can serve as a first-line diagnostic tool for oncology care in resource-limited settings. FNAC maintains excellent accuracy levels and clinical correlation, making it a vital diagnostic tool for rapid and precise cancer diagnosis.