Natural versus synthetic fixative in oral cytological smears – A double blind study

Objective: Fixation in cytology is to preserve and maintain clear and consistent morphological features. Ethanol is most commonly used a gold standard fixative in cytology, but it has few disadvantages such as expensive, flammable, evaporates easily, subjected to pilferage and not easily available. So honey can be used as fixative as it contains several minerals, trace elements, vitamins, carbohydrates and acts as a fixative because of its inherent properties by enabling cellular preservation and dehydration. Considering this objective of present study is to evaluate the fixative properties of honey in comparison with ethanol in a double blinded manner. Materials and Methods: Two oral smears were obtained from each individual (n=50) by gently scraping the buccal mucosa. One slide was fixed in ethanol (95%) and the other in honey (20% processed) for a minimum of 15 minutes and stained with Papanicolaou stain. Two separate pathologists who were blinded for the fixative used evaluated the slides for 5 parameters (Cell morphology, Nuclear and Cytoplasmic staining, Clarity and uniformity of staining,). Results: Among 50 cases evaluated by both pathologists, results showed that honey fixed smears had acceptable nuclear and cytoplasmic staining, well preserved cell morphology, clarity and uniformity of staining as comparable to ethanol with no statistical difference between both fixatives. Conclusion: Hence in search of a better, eco-friendly and cost effective fixative, 20% processed honey can be efficiently used in cytological smear fixation for the preservation of cellular details.