Background: Cervical Lymphadenopathy is one of the commonest and sometimes only clinical finding for a benign and malignant lesion. Fine needle aspiration cytology (FNAC) is a simple, safe, rapid and inexpensive method for establishing the diagnosis of lesions. Metastasis is more common in cervical lymph node and enlarged cervical nodes in an elderly patient must be considered as metastatic until proved otherwise. Methods: Retrospectively, 320 cases of left cervical lymph node FNAC were collected from five years record (May 2010 - June 2014) at Sri Devaraj Urs Medical College, Tamaka, Kolar. Review of all cytological reports were done according to standard guidelines and the morphological features of all non-neoplastic and neoplastic lesions were analysed. Results: Out of 320 cases 33% showed reactive lymphadenitis, 29% showed metastatic deposits, 14% showed features of granulomatous and necrotizing lymphadenitis, 9% were tuberculous lymphadenitis. In the present study, reactive lymphadenitis was the most common cause of enlarged lymph nodes followed by metastatic deposits. Squamous cell carcinoma is the most common metastatic lesions of lymphnode and comprise of 65% of the cases. Out of 62 cases of SCC 74% were keratinized, 16% were non keratinized, 29% cases showed granulomas. Non keratinization, presence of granuloma, plasma cells and eosinophils favours metastasis from nasopharyngeal carcinoma. Keratinization favours squamous cell carcinoma and absence of eosinophils and plasma cells in the background favors SCC metastasis from other sites. Conclusion: The present study highlight the usefulness of FNAC in left cervical lymphadenopathy where metastasis is common. Thus the knowledge about the cytological features and patterns will help the clinician to detect the respective cases early for investigations and treatment