The proportion of extra-pulmonary tuberculosis has risen to over a third of the cases ofrntuberculosis in Ethiopia. The majority of this form of tuberculosis is reported as lymph noderntuberculosis (LNTB). We evaluated the national algorithm currently in use for the diagnosis ofrnlymph node enlargement in Ethiopia. One hundred and fifty suspected cases of lymph noderntuberculosis, aged 5-65 years, with extra-inguinal lymphadenopathy were recruited following thernnational algorithm, from October 2004 to August 2005. Out of these individuals, 117rn(78%) were diagnosed as LNTB on positive culture of fine needle (FNA) and/or biopsyrnspecimens. FNA cytology (FNAC) and histopathology detected 88 (75%) and 105 (97%) of thernculture proven LNTB patients, respectively. Eighty percent of DNA extracted from biopsyrntissues gave signal for M. tuberculosis. All of the strains isolated from culture were identified asrnM. tuberculosis. Ziehl-Neelsen (ZN) staining of FNA and biopsy smears detected acid fastrnbacilli (AFB) in 28% and 25% of the patients, respectively. Macroscopic caseation in excisedrnlymph node and aspirated material was found to be comparable with 79 (68%) of the nodes andrn78 (67%) of the fine needle aspirates demonstrating caseation. Statistically significantrnassociation was found between the presence of caseation and the diagnosis of LNTB in bothrntypes of specimens (p=0.002). Combination of FNAC, ZN staining of FNA materials andrnmacroscopic examination of aspirates detected 112 (96%) of the culture proven LNTB patients.rnThe proportion of HIV seropositive individuals among the culture proven LNTB patients werern24%. There was statistically significant association between urban residence (p=0.002), femalerngender (p=0.006) and HIV in LNTB patients. There was no statistically significant associationrnbetween LNTB and HIV. We found that the currently used algorithm detects a significantrnamount of culture proven LNTB patients even though it suffers from shortcomings. It is hopedrnthat this will encourage wider consultation to review and revise the existing algorithm and improve LNTB diagnosis and reporting nationwide