Background: Image-guided fine needle aspiration cytology (FNAC) has been used to evaluate mediastinal lesions. Methods: Case records of 28 patients with thymic lesions who had undergone computed tomography (CT) - or ultrasonographyguided FNAC of thymic lesions over a period of four years (January, 2012 – December, 2015), retrieved from the cytology register, were retrospectively studied. Malignant lymphomas were excluded. Four smears were prepared for each case; two were stained with Papanicoulaou (Pap) stain and two were stained with May-Grunwald Giemsa (MGG) stain. A cell block was prepared in cases where adequate material was available using formalin fixation and agar method. Immunohistochemistry on cell block was done wherever required and feasible. Final diagnosis was made on the basis of the cytological and histopathological findings (in those cases that underwent biopsy/surgery), and considering the clinical and radiological findings. Results: Thymoma accounted for the majority of the cases (n=19; 67.8%), thymic carcinoma (n=6; 21.4%), thymic hyperplasia (n=1; 0.04%), thymolipoma (n=1; 0.04%) and thymic neoplasia (n=1; 0.04%). Conclusions: Image-guided FNAC with ancillary tests can be a powerful diagnostic tool in the diagnosis of thymic neoplasms. Although a diagnosis by FNAC has often proved challenging in this area, image guided FNAC along with ancillary techniques can provide an accurate diagnosis, especially in thymic neoplasms.