REVIEW ARTICLE
Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: Is it really necessary?

https://doi.org/10.1016/j.ijporl.2005.05.005Get rights and content

Summary

Objective:

To evaluate the necessity of histopathologic examination for routine tonsillectomy and/or adenoidectomy in terms of unexpected malignancy by evaluating a large group of pediatric patients retrospectively with review of the literature.

Materials and methods:

A retrospective chart review of all patients under the age of 19 who underwent tonsillectomy and/or adenoidectomy between January 1990 and January 2005 was carried out. The records were analyzed concerning each patient's age, sex, indication for surgery, type of surgical procedure and the result of histopathologic examination of the specimen. The patients operated for chronic or recurrent infections and obstructive hypertrophy were included in the study. Moreover, the English literature was searched in Medline for articles published between 1949 and March 2005 and the studies dealing with pathologic analysis of tonsillectomy and/or adenoidectomy specimens were reviewed.

Results:

The total number of patients was 2826. After excluding 83 patients because of insufficient data, 2743 patients with an age distribution from1 to 18 years (mean: 7.53) were reviewed. There were 1534 males (56%) and 1209 females (44%). Tonsillectomy and adenoidectomy were performed together on 1930 patients (70%) while tonsillectomy and adenoidectomy alone were performed on 287 (10%) and 526 (20%) patients, respectively. Evaluation of the pathology reports revealed no malignancies. Review of the literature identified 14 articles and 5 of them included only pediatric patients. The rate of unexpected malignancies observed in these pediatric series varied between 0 and 0.18%.

Conclusion:

After being evaluated by an experienced otolaryngologist, pathologic evaluation of all specimens may not be necessary if a child undergoing routine tonsillectomy and/or adenoidectomy is not found to have certain preoperative risk factors.

Introduction

Tonsillectomy with or without adenoidectomy is the most common major surgical procedure performed by otolaryngologists in the pediatric population [1]. While recurrent or chronic infections and obstructive sleep apnea are the major indications, tonsillectomy and/or adenoidectomy can be performed as a biopsy procedure to exclude malignancy. Today the controversy about the necessity of histologic examination of all the tonsillectomy and adenoidectomy specimens continues since the incidence of unexpected pathologies are extremely low in childhood [2], [3], [4].

The main reason of investigating the necessity of pathologic examination in routine tonsillectomy and/or adenoidectomy specimens is to decrease the cost and consumption of manpower, which are very important issues in today's world. On the other hand, this approach must not cause some unexpected diseases especially malignancy to be missed and affect adversely their prognosis by delaying the treatments of the patients [5].

In this study, the necessity of histopathologic examination for tonsillectomy and/or adenoidectomy was assessed in terms of unexpected malignancy by evaluating a large group of pediatric patients retrospectively with review of the literature.

Section snippets

Materials and methods

A retrospective chart review of all patients under the age of 19 who underwent tonsillectomy and/or adenoidectomy between January 1990 and January 2005 was carried out at the University of Dokuz Eylul. The records were analyzed concerning each patient's age, sex, indication for surgery, type of surgical procedure and the result of histopathologic examination of the specimen. While the patients operated for chronic or recurrent infections and obstructive hypertrophy were being evaluated, the

Results

The total number of patients was 2826. After excluding 83 patients because of insufficient data, 2743 patients with an age distribution from1 to 18 years (mean: 7.53) were reviewed. There were 1534 males (56%) and 1209 females (44%). Tonsillectomy and adenoidectomy were performed together on 1930 patients (70%) while tonsillectomy and adenoidectomy alone were performed on 287 (10%) and 526 (20%) patients, respectively. Evaluation of the pathology reports revealed no malignancies.

Review of the

Discussion

It is a general rule to send all the surgically removed tissues for routine histologic examination in our institution where tonsillectomy and adenoidectomy specimens constitute the most common surgical specimens of our department. Our study evaluating the results of the microscopic examination of 2743 routine tonsillectomy and/or adenoidectomy specimens in terms of unexpected malignancy revealed no malignant tumor.

Routine tonsillectomy and/or adenoidectomy is almost always performed for chronic

References (21)

There are more references available in the full text version of this article.

Cited by (0)

View full text