Telepathology is useful when distance is an obstacle to timely diagnosis. Performance of fine-needle aspiration (FNA) at locations distant from cytopathologists can limit timely assessment of adequacy and preliminary diagnosis. We evaluated a telepathology system for consultation between residents and faculty for assessment of FNA specimen adequacy and preliminary diagnosis using 100 consecutive cases. We compared findings with the original assessment of adequacy, preliminary interpretation, and final diagnosis. Two residents initially screened 50 cases, and images were then transmitted to cytopathologists, who communicated by telephone. We found 97% diagnostic concordance and 99% accuracy. The screening time ranged from 41 seconds to 30:19 minutes (mean, 6:35 minutes). The viewing time ranged from 10 seconds to 12:50 minutes (mean, 3:52 minutes). Our telepathology system is efficient and accurate for the initial assessment and preliminary diagnosis of FNA specimens, but we recommend its use by more senior and experienced trainees.