Objective To evaluate the efficacy of aspiration cytology in the early diagnosis of tuberculous dactylitis and describe the spectrum of cytomorphologic features in these cases. Study Design We studied 12 cases of dactyli- tis diagnosed as of tubercular etiology by fine needle aspira- tion cytology (FNAC) over a period of 6 years and assessed the clinicoradiologic features. The stained slides were re- viewed and the spectrum of features noted. Results The most common clinical presentation was an indurated swelling of the involved digit (100%). On radiography, most often an expansile, lytic lesion along with soft tissue swelling was noted in 83% of cases. However, the clinical diagnosis did not consider a tubercular (TB) etiology. FNAC of these cases showed variable features; the most common was granulomas with or without necrosis (75% in total). Two cases showed acute suppurative cytology, and 1 revealed only fibroblasts and a few neutrophils. On the basis of suspicion, staining for acid-fast bacilli (AFB) was done in all cases, and bacilli were identified in all of them after a thorough search.These patients were soon started on antitu- berculous therapy, with significant improvements. Conclusion FNAC can serve as an inexpensive and comparatively less invasive procedure for early diagnosis of TB dactylitis, permitting timely initiation of specific therapy. This study also highlighted the unusual cytomorphology in some cases. Clinicians and pathologists should maintain a high index of suspicion in cases of dactylitis and stain for AFB in all cases. (Acta Cytol 2006;50:669– 671) Keywords: fingers; tuber- culosis; aspiration biopsy, fine-needle; tubercular dac- tylitis. T uberculosis (TB), especially extrapulmonary, in- cluding skeletal, is reemerging as a major cause of morbidity in children with the advent of AIDS. 1 Skeletal TB constitutes 10–15% of extrapulmonary cases, with digits accounting for only 4% of these cases. 2 The clinical and radiologic features are suffi- ciently nonspecific to lead the clinician and radiologist not to suspect tubercular etiology of dactylitis. Thus, the mainstay of diagnosis rests on histopathologic demonstration of granulomatous lesions with or with- out caseous necrosis since acid-fast bacilli (AFB) may not be demonstrated. 3 The role of cytology in the diagnosis of TB dactyli- tis has not been investigated so far. In this study, we at- FNAC can be widely used as a diagnostic tool in these cases, and staining for AFB...is mandatory in all suspected cases. Tubercular Dactylitis Fine Needle Aspiration Cytology as a Diagnostic Modality Sompal Singh, M.D., Ruchika Gupta, M.D., Shyama Jain, M.D., and Neeta Kumar, M.D. From the Department of Pathology, Maulana Azad Medical College, New Delhi, India. Dr. Singh is Senior Research Associate. Dr. Gupta is Resident. Drs. Jain and Kumar are Professors. Address correspondence to: Shyama Jain, M.D., 20/59, Lodhi Colony, New Delhi-110003, India (jainshyama@rediffmail.com). Financial Disclosure: The authors have no connection to any companies or products mentioned in this article. Received for publication May 20, 2005. Accepted for publication October 31, 2005. Fine Needle Aspiration 0001-5547/06/5006-0669/$19.00/0 © The International Academy of Cytology ACTA CYTOLOGICA 669 DO NOT DUPLICATE © Copyrighted Material