Aim:This study aimed to compare the diagnostic accuracy of different cytological sampling techniques, including bronchial brushing, bronchoalveolar lavage (BAL), and transthoracic fine-needle aspiration (TTFNA), in diagnosing suspected pulmonary lesions, with histopathology as the gold standard.Materials and Methods:This prospective study was conducted in the Department of Pathology at Subharti Medical College, Meerut, from September 2011 to July 2013. Cytological samples were obtained from 178 patients via BAL, bronchial brushings, and TTFNA. Histopathological correlation was available for 47 cases. The adequacy of samples was determined based on established guidelines. Diagnostic accuracy, sensitivity, specificity, and predictive values were calculated for each technique.Results:Of the 178 cases, BAL was performed in 135 (75.84%) patients, brushings in 44 (24.72%), and TTFNA in 57 (32.02%) cases. Maximum malignancies were detected by TTFNA, with a sensitivity and specificity of 100%. For BAL, diagnostic accuracy was 71.4%, and for brushings, it was 87.5%. Histopathological confirmation was available in 47 cases, with squamous cell carcinoma being the most commonly diagnosed malignancy.Conclusion:TTFNA demonstrated the highest diagnostic accuracy, followed by bronchial brushings and BAL. Each method's effectiveness varies depending on the lesion type and location, emphasizing the importance of using multiple diagnostic modalities for pulmonary lesions.