Leishman-Giemsa Cocktail - Is it an Effective Stain for Air Dried Cytology Smears

Abstract

INTRODUCTIONFine Needle Aspiration Cytology (FNAC) is a preliminary diagnostic procedure for wide spectrum of non neoplastic and neoplastic lesions. It is safe faster and cost effective procedure. It is quick, easy to perform and has high grade specificity and sensitivity. It is used as a primary investigation procedure in all the suspected neoplastic conditions before any surgery [1].Routinely various stains like Haematoxylin and Eosin (H&E), Romanowsky and Pap have been used for staining the FNAC smears. Romanowsky stains are routinely used for staining the blood films and air dried cytological smears [2]. The different types of Romanowsky stains available are MGG, Wright Giemsa stain, Leishman stain and Diff Quick. These stains allow better estimation of cell size, nuclear size, cell cytoplasm and identify ground substances by metachromasia [3,4]. MGG is routinely used in cytology for air dried smears in many laboratories. This stain demonstrates the cytoplasmic features but not the nuclear chromatin well and the procedure is time consuming and stain has tendency to precipitate [5]. Leishman stain is a good nuclear stain which is used widely in haematology [6].LG cocktail is a new staining technique with very few studies in the literature describing its applicability in cytology. Few authors have opinioned that LG cocktail stain provides an excellent cytoplasmic and nuclear staining comparable to Pap stain and superior to MGG in both staining quality and diagnostic ability in exfoliative cytology and also has a potential application in the screening programmes [6]. Hence, the study was done to evaluate the quality of staining of LG cocktail in air dried cytology smears and compare the quality of staining of LG cocktail with MGG. MATERIALS AND METHODSThis prospective study was done at a tertiary care centre. The number of cases studied was 100 for duration of two months.Before starting the study ethical clearance was taken from the Institutional Ethical Committee. It included all the patients who were sent to cytology department for FNAC. Informed consent was taken from patient for the FNAC procedure. Cases with inadequate material were excluded from the study. Extra slides were made from the FNAC material. These smears were stained with MGG (Himedia, India) and LG cocktail -Combination of Leishman stain (Chromo span, India) and Giemsa stain (Nice, India) respectively.A total of 200 slides were screened by two pathologists. The slides were stained with MGG by using conventional method. The LG cocktail was prepared by the using the following protocol [2]:1) The unit volume of Giemsa was mixed with equal amount of distilled water to prepare Giemsa working solution (1:1 dilution);2) An equal volume of Leishman's stain was filtered and mixed with an equal volume of the above Giemsa working solution (1:1);LG cocktail staining procedure [2]: The air dried smears were flooded with LG cocktail and left for one minute. An equal volume of buffer/distilled water was added and left for six minutes. The slides were washed ...

Comparative Durability of Common Stains Used for Exfoliative Vaginal ‎Cytology

“…The combination of two stains may produce better result. For instance, Leishma-Giemsa cocktail reportedly produced better results compared to May Grunwald Giemsa (MGG) for examination of air-dried fine needle aspiration cytology (Doddagowda et al, 2017). A similar study to compare between Papanicolaou and crystal violet stains in vaginal cytology of rat preferred Papanicolaou to Gentian violet on the ground that the former produced a more detailed and clearer nuclear and cytoplasmic details (Srinivasan et al, 2017).…”

“…Image quality was based on four parameters that include (i) background material staining, (ii) overall staining, (iii) cytoplasmic staining and (iv) nuclear staining. Each parameter had a score range of 0, 1, 2, and 3 in order of being poor, satisfactory, good and excellent respectively as was described in earlier study (Doddagowda et al, 2017). The actual score (0-3) for each of the four categories of the cells aforementioned above made up the total actual score.…”

Cellular composition and cytomorphological characteristics of periodontal pockets of patients with periodontitis using Leishman‐Giemsa cocktail staining

“…The overall maximum possible score in the study was calculated by multiplying the number of cases by 12 for each of the two stains. Quality indicators of the stain was obtained by the ratio of actual score obtained divided by maximum with Pap stain and LG cocktail, score possible 17 …”

Modified Giemsa Stain: A solution to improve the quality of hypercellular bone marrow smears

“…15 Therefore, the strength of the staining by Giemsa is more than that of Leishman. There are previous studies carried out, trying new cocktail methods of Leishman and Giemsa stains to see whether the staining quality of the smears improves 16,17 but there have been no studies so far of an improved Giemsa staining method alone which is cheaper and effective for the bone marrow staining.…”