Evaluation of the Utility of histopathologic exam as a routine in Tonsillectomies

Abstract

Tonsi llectomy is one of the most commonly performed procedures of the head and neck. It is performed for a wide variety of indications in both adults and children. It is common to send the material achieved in the surgery to routine histopathologic exam, as to analyze suspected material or for a medical-legal documentation. Objective: Analyze the utility and cost of routine histopathologic diagnosis for tonsillectomy. Methodology: retrospective study of the histopathologic result of all tonsillectomies between 1978 and 2004 in a university hospital and analyzed the files of the patients with cancer. Results: 2103 results of histopathologic exams were analyzed. Of these, only four cases presented any case of malignancy, being all of these non-Hodgkin lymphoma and already suspected before the surgery. Discussion: The world literature has encountered similar results and each time more the histopathologic analysis of all cases is questioned. The cost of the exam is high and your results, in the case of malignancy were already knew before the surgery. Conclusion: Histopathologic analysis of all tonsillectomies is not indicated. The risks factors established by Beaty should guide the solicitation of the exam, to try to low the costs with unnecessary exams.

Are Histologic Studies of Adenotonsillectomy Really Necessary?

“…The examinations did not locate any hidden malignancies. 6 Williams and Brown found 4,070 tonsils with malignancy on histopathology, and all of them had been diagnosed during preoperative evaluations. 7 A study by DellAringa et al showed no malignancy in the patients analyzed, finding a negative cost–benefit ratio for routine histopathologic exams.…”

Histopathological screening of tonsillectomy and/or adenoidectomy specimens: A report from southern Iran

“…The authors, who prefer not to send specimens from routine tonsillectomies or idectomies in children for microscopic examination, recognize that the most common reason for this conservative approach is to save costs and the consumption of manpower [20]. In 1998, after analyzing 476 tonsillectomies, Beaty proposed as risk factors for tonsillar malignancy: previous history of head and neck cancer, tonsillar asymmetry, visible or hard lesion on palpating, unexplained weight loss or constitutional symptoms, and neck mass [21].…”

“…The authors also recommend that because of economic conditions all specimens from routine T&A should be sent for gross pathologic examination, if were abnormal then should be processed for microscopic study. Weibel [15] 4680 3 0 (0) Daneshbod et al [11] 15,120 2 1 (0.006) Dohar and Bonilla [16] 2012 1 0 (0) Netser et al [12] 2700 10 2 (0.07) Alvi and Vartanian [14] 103 3 1 (1) Reiter et al [17] 1320 23 0 (0) Strong et al [3] 1583 0 0 (0) Williams and Brown [18] 4070 2 0 (0) Garavello et al [13] 1123 0 2 (0.18) Erdag et al [2] 2743 0 0 (0) Dell'Aringa et al [10] 250 1 0 (0) Devil et al [19] 2989 0 0 (0) Felix et al [20] 2103 0 0 (0) Present study 5058 18 1 (0.19) …”

A Comprehensive Analysis of Histopathologic Examination Results of Tonsillectomy Specimens

“…In addition, it is still unclear that in which cases histopathologic examination is required. Felippe et al reviewed 2013 adult and pediatric patients who underwent adeno-tonsillectomy and reported malignancy in 4 (0.19%) patients [18]. In the report by Younis et al, malignancy was not detected in 2099 pediatric patients and was detected in 40 (11.79%) of 339 adult patients.…”