Background: The triple assessment of clinical breast exam (CBE), fine needle aspirate cytology (FNAC) and breast ultrasonography (US) is used in many settings for the diagnosis of fibroadenoma (FA). The diagnostic accuracy of FNAC and US for FA in South African (SA) women with palpable breast masses (PBM) is unknown. Objective: To report the diagnostic accuracy of FNAC/US for FA in SA women with PBM. Methods: We conducted a retrospective pilot diagnostic study of 91 women who presented with PBM to a SA regional academic hospital. Data for CBE, US, unguided FNAC, and open biopsies was collected from study participant medical records and analyzed using diagnostic accuracy tables. Results: A total of 57/91 (62.6%) study participants had uninterpretable FNAC results. No study participants had uninterpretable US results. The overall diagnostic accuracy of FNAC for FA was 36.3% (95% Confidence Interval - CI: 27.1-46.5%). The overall diagnostic accuracy of US for FA was 83.5% (95% CI: 74.6-89.8%). Conclusion: The yield of interpretable test results for FNAC was poor in our study. The diagnostic accuracy of US for FA appears to be superior to that of FNAC. Omission of FNAC from the triple assessment in our setting should be considered. .