Comparing the Staining Efficacy of Leishman Giemsa Cocktail with MGG and Leishman Stain in Fine Needle Aspiration Cytology Smears: A Cross-sectional Study

Introduction: Fine Needle Aspiration Cytology (FNAC) is a primary investigative tool for diagnosing both non-neoplastic and neoplastic swellings. It is safe, rapid, cost-effective, and has high sensitivity and specificity. FNAC smears are routinely stained using Haematoxylin and Eosin (H&E), Papanicolaou (PAP), and May-Grünwald-Giemsa (MGG) stains. The LeishmanGiemsa cocktail (LG cocktail) is a relatively new stain composed of a mixture of Leishman and Giemsa stains. Leishman stain is widely used for haematology smears but is not commonly employed for cytology smears. The present study evaluates the staining efficacy of the LG cocktail and compares it with MGG and Leishman stains in FNAC smears. Aim: To analyse the staining efficacy of the LG cocktail stain in FNAC smears and to compare the Quality Index (QI) of the LG cocktail with MGG and Leishman stains in FNAC smears. Materials and Methods: The present cross-sectional study carried out on 100 FNAC cases at Thanjavur Medical College and Hospital over a period of one month (July 2023), following approval from the Institutional Ethics Committee (Approval No. 1121/2023). FNAC samples were obtained from patients referred from the Department of General Surgery OPD and the Department of Otorhinolaryngology OPD. Informed consent was obtained from all participants. Apart from the routine smears prepared for H&E and MGG staining, two additional smears were prepared for each case and stained with the LG cocktail and Leishman stain. The stained slides were evaluated and scored for nuclear morphology, cytoplasmic details, clarity of staining, background details, and overall staining quality. Each parameter was graded as satisfactory, good, or excellent. The QI was calculated by dividing the score obtained by the maximum possible score. The QI values of MGG, LG cocktail, and Leishman stains were analysed for statistical significance using Statistical Package for the Social Sciences (SPSS) software version 26, and paired sample tests were applied. Results: The QI of the LG cocktail stain was 0.76, while that of MGG was 0.67 and Leishman stain was 0.46. Smears stained with the LG cocktail demonstrated excellent nuclear and cytoplasmic details, better background material staining, and superior overall staining efficacy compared with MGG and Leishman-stained smears. Conclusion: The LG cocktail stain demonstrated superior staining efficacy in FNAC smears when compared with MGG and Leishman stains. Although Leishman stain requires a shorter staining duration and is more economical, its cytoplasmic detail and background staining are inferior. Therefore, Leishman stain alone is not preferred for FNAC smears.