Need for routine histopathological examination after adenotomy, tonsillotomy or tonsillectomy

Objective:

It is debatable whether adenotomy (AT), tonsillotomy (TT) and tonsillectomy (TE) in children must be routinely histologically examined.

Methods:

OPS-query for AT, TT and TE in adenoids, chronic tonsillitis, tonsillar hyperplasia and OSAS of ENT University Hospital Mainz from 2011 – 2016. File search for clinical abnormalities and histological findings. Survey to determine the current practice in German ENT clinics.

Results:

n = 2165 patients (4 months-77 years). Of which n = 1132 (47%) AT, n = 295 (12%) TT < 18 and n = 987 (41%) TE, with n = 316 (32%) < 18 and n = 671 (68%) ≥18. In n = 2148 (99.2%) cases a histology was performed, in n = 17 (0.8%) it was waived. In 99.9% the diagnosis was confirmed histologically, in 0.1% there was a deviation without malignancy. Clinical abnormalities were observed in 4% (n = 82 asymmetry, n = 4 unilateral hardening, n = 3 cystic changes), these showed no histological correlate. The response rate of the survey was 42% (n = 68/162). In the hospitals surveyed, histology is performed in children after AT in 57%, TT in 66% and TE in 76%. In adults histology is carried out in 84% after TT and 94% after TE. 28% consider histology of adenoids in children to be indicated, in TT 37% and TE 50%; in adults 78% and 87% respectively. For AT, TT, TE in children costs for histology per year resulted in approximately € 9300.

Conclusion:

The rate of malignant incidental findings after routine AT, TT or TE are well below 1%. Our data support the fact that in many places children are left without histology in the absence of clinical abnormalities. From an economic point of view there is certainly a relevant cost reduction potential. In adults, a histological examination appears useful, mainly for medico-legal reasons.

Publication History

Publication Date:
18 April 2018 (online)