Is Honey a Reliable Substitute for Formalin in Histopathological Analysis- A Scoping Review.

Abstract

Introduction: Formalin has long been regarded as the gold standard for tissue fixation in histopathology. However, its potential health hazards, including carcinogenicity, have prompted the exploration of safer, natural alternatives. Honey, a biocompatible and naturally available substance, exhibits antibacterial and tissue-preserving properties, making it a potential fixative.

Objectives: To assess the effectiveness of honey as a fixative in histopathological tissue processing and compare its histomorphological outcomes with formalin and other natural fixatives.

Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Embase databases for studies published in English. Original research articles evaluating honey (processed or unprocessed) as a fixative in human or animal tissue samples, with formalin or other natural fixatives as comparators, were screened based on inclusion and exclusion criteria, followed by data extraction.

Results: Out of 107 identified articles, 12 met the inclusion criteria. Most studies reported that honey at low concentrations (typically 10%) and low pH (4.5–5.0) preserved the structural morphology comparable to formalin. Processed honey showed better results than unprocessed variants.

Conclusions: Honey with a low concentration of 1:10 and low pH can be used as a safe alternative to formalin. Further research with standardized protocols is needed for broader application.