Background: Tuberculous lymphadenopathy is an important form of extrapulmonary tuberculosis. The role of fine needle aspiration cytology (FNAC) in the diagnosis of such lesions is a well-known fact. Aims: To study the distribution of cytomorphological patterns of tuberculous lymphadenitis and role of repeat aspiration in diagnosing tuberculous lymphadenitis. Methods: The study was conducted in the department of Pathology in a tertiary care hospital in central India from January 2022 to March 2023. Detailed clinical history with relevant investigations were taken. FNACs were done and the smears were stained with May-Grünwald Giemsa and Ziehl-Neelsen stain. Results: Out of 180 lymph node aspirations 74 cases were diagnosed as tuberculous lymphadenitis. Four cytomorphologic patterns were observed: 1) Caseating epithelioid granulomas: 42 cases (56.7%). 2) Non caseating Granulomatous: 23 cases (31.1%). 3) Necrotising lymphadenitis: 7 cases (9.4%). 4) Necrotising and suppurative: 2 cases (2.8%). AFB positivity was seen in 32 cases (43.24%). 58 cases showed reactive lymphadenitis repeat aspiration was advised after a course of antibiotics. Out of 18 cases that turned-up for re-aspiration, 11 cases showed subsequent development of epithelioid granulomas, whereas the others still had reactive features. Conclusion: FNAC is a useful tool in the diagnosis of tuberculous lymphadenitis and repeat aspiration after 2-3 weeks helps in providing the correct diagnosis of early tubercular lesions.