The cytological examinations of serous effusions have been well-accepted, and a positive diagnosis is often considered a definitive diagnosis. The study was planned to determine the diagnostic utility of fluid cytology by conventional smear and cell block method in pleural effusion. This was a hospital-based open cohort observational study conducted on patients diagnosed with pleural effusion. The study period was one year, and patients were recruited using a nonprobability sampling method. The fluid samples were subjected to the conventional smear examination, followed by cell block preparation. The overall morphologic details, cellularity, architecture, and nuclear and cytoplasmic details were studied and compared in conventional smear and cell block techniques. The samples were categorized as unsatisfactory, benign, suspicious for malignancy, or malignancy. The study was conducted on 113 pleural fluid samples. The study demonstrated that the cell block technique improved the cellular yield and established diagnosis in malignant effusions.