Cytopathology is a cost-effective diagnostic method crucial for investigating suspected neoplastic lesions, particularly in Nigeria's healthcare system, where non-communicable diseases, especially with increasing rates of cancer. This review highlights the evolution of cytopathology practice in Nigeria, detailing its historical development, current methodologies, and the challenges faced within the healthcare framework. Despite advancements in diagnostic techniques such as immunocytochemistry and molecular diagnostics globally, conventional methods remain essential due to their affordability and accessibility. Fine needle aspiration cytology (FNAC) has gained acceptance for its diagnostic accuracy
however, significant disparities exist in the availability of cytological services across various regions. The lack of trained personnel and inadequate infrastructure further complicate the effective implementation of cytopathology practices. The findings highlight the urgent need for specialized training programs and improved resource allocation to enhance cytopathology services in Nigeria. We advocate for strategic interventions aimed at optimizing cytopathology's potential to improve cancer diagnosis and patient outcomes in resource-limited settings across the country.