Objective: This study aims to comprehensively investigate the cytomorphological spectrum of tuberculous lymphadenitis and establish a robust correlation with Acid-Fast Bacilli (AFB) positivity. Methods: The study was conducted in the Department of Pathology at GMC Jammu, involving 130 clinically suspected patients of tubercular lymphadenitis. The study spanned from March 2021 to February 2022, during which fine needle aspiration cytology (FNAC) was performed on enlarged lymph nodes after obtaining informed consent from each patient. Detailed clinical history was documented, and palpable nodes were aspirated. Smears were stained with FNAC, and one slide was left unstained in each case for Ziehl-Neelsen staining. Out of the 130 cases, 90 exhibited cytological features indicative of granulomatous lymphadenitis.Results: The predominant age group affected was 21-30 years (37.8%), with a mean age of 32.8±7.54 years. Females constituted 52.2% of the cohort. Fever (72.2%) emerged as the most common symptom. Cervical lymph nodes were predominantly involved (82.2%), with "Pattern B" being the most prevalent cytological pattern (51.11%). Correlation analysis demonstrated that "Pattern C" (Necrosis only) exhibited the highest AFB positivity rate (36%), followed by "Pattern B" (17.4%) and "Pattern A" (5.3%). The overall AFB positivity rate was 20.0%. Conclusion: The study provides valuable insights into the cytomorphological spectrum of tuberculous lymphadenitis and establishes a significant correlation with AFB positivity. The findings contribute to refining diagnostic approaches and improving the overall management of this extrapulmonary manifestation of tuberculosis. Further research may elucidate additional nuances, aiding clinicians in more accurate and timely diagnoses.