Background <p>Tumors of the parotid gland can be challenging to evaluate preoperatively due to variable presentations and the potential for malignancy. The objective of this study was to compare preoperative fine needle aspiration cytology (FNAC) results and magnetic resonance imaging (MRI) findings with final pathology outcomes in individuals identified with parotid tumors.</p> Methods <p>We conducted a retrospective analysis of 168 patients who underwent parotidectomy in our clinic between 2018 and 2024. Both ultrasound-guided FNAC and MRI were performed in all patients before surgery. Results were categorized as benign, malignant, or nondiagnostic and compared with final pathology. MRI findings were similarly categorized as benign or malignant. Statistical analyses were performed to assess the sensitivity, specificity, and accuracy of both diagnostic modalities.</p> Results <p>Among the 168 cases, 148 (88%) were identified as benign lesions, while 20 (12%) were malignant. The most common benign lesions identified were pleomorphic adenoma and Warthin tumor. The sensitivity, specificity, and accuracy for detecting malignant lesions were 76%, 99%, and 96% for FNAC, and 70%, 96%, and 93% for MRI, respectively. Additionally, the positive and negative predictive values were 93% and 96% for FNAC, and 93% and 95% for MRI, respectively.</p> Conclusion <p>Our findings indicate that FNAC and MRI exhibit comparable efficacy in differentiating between benign and malignant lesions of the parotid gland. However, MRI provides critical additional information regarding the size, location of the masses, and their relationships with adjacent structures, thereby enhancing the overall treatment planning.</p>