AIM To determine the value of nonimaging-guided (direct) fine-needle aspiration cytology in diagnosing liver lesions.METHODS Detection by technetium-99m, ultrasound or computed tomographic scanning of the liver was made in 279 patients with 332 aspirations.RESULTS Based on histologic, cytologic and clinical findings, final liver diagnoses were reached in 265 patients, of whom 171 had malignant and 94 benign liver disease. Among the 171 patients with malignant liver disease, the cytologic findings indicated suspected malignancy in 8 patients, suggested definite malignancy in 130, but failed to disclose malignancy in 33 patients. In 93 of the 94 patients with benign liver disease, the cytologic findings were reported as benign, while in one patient the report of malignancy was false. The overall sensitivity, specificity, and positive and negative predictive values for cytologic results were 80.7%, 98.9%, 99.3% and 73.8%, respectively. The diagnostic accuracy of fine-needle aspiration cytology was 87.2%. The only major complication attributable to the procedure consisted of one case of pneumothorax.CONCLUSION Direct fine-needle aspiration of palpable liver mass and blind fine-needle aspiration of non-palpable liver lesions for cytodiagnosis are simple, safe, and cost-effective diagnostic method for evaluating the nature of liver lesions. The aspiration procedure including potential complications could be cut short by early finding of abnormal cells.