Incidence of unexpected malignancies in routine tonsillectomy specimens in children

OBJECTIVES: Controversy continues to exist regarding the necessity to routinely send for histologic examination those specimens obtained after tonsillectomy with or without adenoidectomy in children. Otolaryngologists fear missing an unsuspected diagnosis, such as a tonsil malignancy. However, given the rare incidence of this event, the cost-effectiveness ratio of routine microscopic analysis is questionable. The purpose of this study was to assess the incidence of clinically relevant unexpected diagnosis among children who underwent tonsillectomy with or without adenoidectomy in our units and to review current available series on this topic. STUDY DESIGN: Retrospective study and review. METHODS: All patients aged less than 16 years who underwent routine tonsillectomy (with or without adenoidectomy) at San Gerardo Hospital, Monza, Italy from January 1994 to June 2002 were reviewed. Histologic examination is routinely performed in our units. Patients were excluded if the primary indication for surgery was to rule out a tonsil malignancy. RESULTS: One thousand one hundred twenty-three (1,123) patients were recruited. Two cases of non-Hodgkin's lymphoma were detected, corresponding to a rate of 0.18% (95% confidence interval [CI] 0.07-0.56). Three previously published series were identified. The reported incidences of unexpected clinically relevant diagnoses varied between 0.0% and 0.05%. CONCLUSIONS: The results of our study highlight that the incidence of unexpected clinically relevant diseases of the tonsil in pediatric patients is low, albeit not extremely rare. This finding could be used to perform a cost-effectiveness analysis.