Background: Comparably efficacy of Microscopic examination for tuberculous lymphadenitis isrndiffers from laboratory to laboratory. Emergence of drug resistant TB still a major challenge inrndeveloping countries. We therefore also investigated the drug resistant patterns and molecularrnepidemiology of mycobacterial isolated from tuberculous lymphadenitis patients.rnMethods: A cross sectional study was conducted from clinically suspected Tuberculousrnlymphadenitis patients. Three smears were prepared; for cytomorphology, Auramine O and ZNrnstaining study. The left-over sample were inoculated onto Lowenstein-Jehnsen (LJ) media. Thernculture isolates were tested by regions of difference (RD9) to distinguish M. tuberculosis fromrnother species of M. tuberculosis complex. Phenotypic, genotypic first-line and genotypic secondlinernrndrugs were tested for resistance pattern of isolates by using GenoType MTBDRplus andrnPhenotypic DST (Drug containing 7H10 Middlebrook Media), and the Spoligotyping strainrndependent polymorphism test were determined. Statistical analysis was done using STATArnversion 11. The sensitivity, specificity, positive and negative predictive values were calculatedrnby considering the culture results as the gold standard.rnResults: Among 211 FNA samples collected; 49.7% (105/211) were positive by Cytology,rn32.7% (69/211) LEDFM, 23.69% (50/211) Culture and 13.7% (29/211). The efficacy of ZiehlNeelsenrnrnas compared to culture, Sensitivity were 30% [95% CI: 17.9-44.6], Specificity 91.3%rn[95% CI: 85.8-95.2]. For LEDFM, the Sensitivity 66% [95% CI: 51.2-78.8] and the Specificityrnwas 77.6% [95% CI: 70.4-83.8]. The Sensitivity and Specificity of Cytology was 78% [95% CI:rn64-88.5], 58.8% [95% CI: 50.7-66.5] respectively. The most predominant Spoligotyping typesrnwere NEW strains following by SIT53 and the overall drug resistance patterns among 50 culturesrnpositive isolates were 14% (7/50); out of this 8% (4/50) isolates were mono resistance for INH,rnwhereas 6% (3/50) isolates were resistance for both INH and Rifampicin.rnConclusion: LEDFM gives a legitimate option in contrast to ZN techniques in terms of itsrnhigher sensitivity, a bit lower specificity. Three MDR-TB cases and heterogeneous strains of M.rntuberculosis and the high extent of INH monoresistance from HIV patients were detected. ThernNEW and SIT53 (T) strains was the most prevailing strains in the study area.