Prevalence and Cytopathological Patterns of Tuberculous Lymphadenitis at a Tertiary Hospital in Eastern Ethiopia

Tuberculous lymphadenitis (TBLN) is the most common form of extrapulmonary tuberculosis and remains a diagnostic challenge due to its variable clinical presentation and diverse cytopathological patterns of fine-needle aspiration cytology (FNAC). The aim of the study is to assess the prevalence and the cytopathological pattern of tuberculous lymphadenitis. A cross-sectional study was conducted at Hiwot Fana Comprehensive Specialized University Hospital in Eastern Ethiopia from January 2019 to December 2022. Cytomorphological patterns were categorized into four patterns: epithelioid cell granuloma without necrosis, epithelioid cell granuloma with necrosis, necrosis without epithelioid cell granuloma and with numerous neutrophilic infiltrates, and caseous necrosis only. Descriptive statistics were used to describe the independent variables. The χ2 test of independence was used to compare proportions between cytopathological patterns. After Bonferroni correction for multiple comparisons, a P-value of <0.0083 was considered statistically significant. A total of 725 patients with lymphadenopathy underwent FNAC during the study period, of whom 383 (52.8%; 95% CI: 48.6%-55.9%) were diagnosed with TBLN by FNAC. Females accounted for 198 (51.7%) of cases. The mean age was 20 ± 15 years. Cervical lymph nodes were the most commonly affected site (77.7%). The most frequent cytopathological pattern was epithelioid cell granuloma without necrosis (32%; 95% CI: 27.2%-36.8%), followed by caseous necrosis only (30%; 95% CI: 25.2%-34.6%). Tuberculosis is a predominant cause of lymphadenopathy, and FNAC plays a critical role in diagnosis, especially in resource-limited settings. Understanding cytopathological patterns can improve diagnostic accuracy and guide clinical decision-making.