<![CDATA[Background: Tuberculosis (TB) remains a major global public health challenge, where rapid diagnosis is vital to interrupt transmission. Although chest radiography and Molecular Rapid Tests (TCM) serve as primary diagnostic pillars, the empirical correlation between specific radiological lesion patterns and molecular confirmation in regional hospital settings remains insufficiently characterized. Objective: This study aimed to analyze the relationship between chest radiography lesion characteristics and Molecular Rapid Test (TCM) results among newly diagnosed pulmonary tuberculosis patients at Ciawi Regional General Hospital (RSUD Ciawi), Bogor Regency, in 2024. Methods: An observational analytic study with a cross-sectional design was conducted involving newly diagnosed pulmonary TB patients recruited via consecutive sampling. Radiographic manifestations (infiltrates, cavitations, pleural effusions, fibrosis, consolidation, and calcifications) and GeneXpert MTB/RIF outcomes were extracted from medical records. Bivariate associations were evaluated using the Chi-Square test ( ) at a significance threshold of . Findings: Among participants, male patients ( , ) and individuals aged years ( , ) constituted the majority. Overall TCM positivity was ( ). A statistically significant association was established between radiological lesion characteristics and TCM results ( ). Cavitary lesions yielded the highest TCM positivity rate ( , ), followed by pleural effusions ( , ). Conversely, infiltrative lesions were predominantly TCM-negative ( , ). Significance: Cavitary destruction strongly correlates with positive molecular detection, whereas infiltrative presentations carry a high risk of diagnostic discordance (TCM negativity). These findings highlight the necessity of integrated diagnostic algorithms to prevent underdiagnosis in radiologically suspicious, paucibacillary cases.]]>
