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

Abstract

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. 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. The total number of patients was 2826. After excluding 83 patients because of insufficient data, 2743 patients with an age distribution from 1 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%. 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.