Discontinuing routine histopathological analysis after adult tonsillectomy for benign indication

Abstract

Routine pathological analysis of tonsil specimens recovered from surgery performed for benign indications, in the absence of any suspicion preoperatively for malignancy, is not supported by current evidence and is not financially sound. Modern evidence does not support the need for even gross specimen analysis in these cases.

Unexpected occult malignancy diagnosed during tonsillectomy surgery for obstructive sleep apnea

“…As mentioned, many previous studies have exhorted the diminishing role of histopathological analysis of tonsillectomy specimens in benign tonsillectomy surgery, with evidence supporting only gross analysis. In the adult patient population, the prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens has been reported to be very low (0.03%; 1 case of squamous cell carcinoma out of 3904 cases, [ 2 ] and 0.015%; 9 cases of lymphoma and 2 cases of squamous cell carcinoma out of 72,322 cases [ 4 ] ). However, given that most cases of malignant tonsil cancer are found after metastasis, it is also true that there is concern about not performing routine histopathological analysis of tonsillectomy specimens due solely to cost-effectiveness in real-world clinical situations.…”

“…[ 1 ] Despite the benign indications for surgery in the vast majority of cases, such as OSA, tonsillectomy specimens are routinely sent for gross and histopathological evaluation for detection of occult malignancy. [ 2 ]…”

“…In the adult patient population, the incidence of malignancy in tonsillectomy specimens has been reported to range from 2% to 10%. [ 2 , 3 ] In these previous studies; however, none of the malignancies were unexpected, except for 1 case (unexpected malignancy in tonsillectomy specimen from a 46-year-old man [ 2 ] ). Furthermore, most of these patients had at least 1 risk factor, including history of head and neck cancer; marked tonsil asymmetry; pathological firmness; enlargement of neck lymph node; unexplained weight loss and constitutional symptoms; or visible lesion on the tonsil (ie, ulcer).…”

“…Furthermore, most of these patients had at least 1 risk factor, including history of head and neck cancer; marked tonsil asymmetry; pathological firmness; enlargement of neck lymph node; unexplained weight loss and constitutional symptoms; or visible lesion on the tonsil (ie, ulcer). [ 2 , 4 ] Many previous studies have investigated the necessity of routine histopathological analysis of tonsillectomy specimen, and most recent studies have suggested that such an analysis in asymptomatic patients and/or those with no risk factors for malignancy is not justified because the probability of identifying an unexpected occult malignancy is exceedingly low. [ 2 , 4 ] Nevertheless, we report an unexpected occult malignancy in a tonsillectomy specimen from a patient with OSA who had no risk factors for malignancy.…”

“…[ 2 , 4 ] Many previous studies have investigated the necessity of routine histopathological analysis of tonsillectomy specimen, and most recent studies have suggested that such an analysis in asymptomatic patients and/or those with no risk factors for malignancy is not justified because the probability of identifying an unexpected occult malignancy is exceedingly low. [ 2 , 4 ] Nevertheless, we report an unexpected occult malignancy in a tonsillectomy specimen from a patient with OSA who had no risk factors for malignancy. This report may also prompt reconsideration of the necessity of routine histopathological analysis of tonsillectomy specimen in patients without risk factors for malignancy.…”