Gall Bladder Carcinoma (GBC) is the most aggressive and most common malignancy of the biliary tract in the world. GBC is common in India and shows rising trend with 10 times more incidence in northern and north eastern region than Southern region. As most of the patients are diagnosed in the advanced stage of cancer, prognosis is dismally poor and early diagnosis is essential. We aim to study the importance of Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) in the early detection and diagnosis of gall bladder malignancy in the suspicious cases of gall bladder lesions. A prospective cytomorphologic analysis of total 580 cases of suspected gall bladder lesions was conducted in the Department of Pathology, SMS Medical College, Jaipur, Rajasthan over a period of 2 years. US guided FNAC of the suspicious lesion was done and diagnosis was made on the basis of their cytomorphological features. The mean age of presentation was 54 years with male: female ratio of 1:2. The most common site for GBC was found to be Fossa (97.4%). According to nature of the smears, 73% were malignant, 18% unsatisfactory, 7% benign and 2% were suspicious. On cytomorphological diagnosis, Adenocarcinoma was found to be the most common of all malignant neoplasm (42%), followed by cholangiocarcinoma (9%), MEN (8%), metastatic (05%), adenosquamous (3%) and squamous cell carcinoma (1.5%). We concluded that US guided FNA is safe, quick and reliable procedure for an early diagnosis and pre therapeutic workup for gall bladder lesions.