Processing of Adenoid and Tonsil Specimens in Children: A National Survey of Standard Practices and a Five‐Year Review of the Experience at the Children's Hospital of Pittsburgh

Abstract

The best means of pathologically examining routine tonsillectomy and adenoidectomy specimens in children remains controversial. Otolaryngologists fear missing an unsuspected diagnosis. However, the cost-effectiveness of microscopic analysis, given the rare incidence of unsuspected diagnosis, is questionable. If a significant pathologic diagnosis is missed, the medicolegal implications could be significant. A questionnaire was sent to 111 members of the American Society of Pediatric Otolaryngology. Additionally, we reviewed our experience at the Children's Hospital of Pittsburgh for the 5-year span from 1989 to 1994 to determine our incidence of unsuspected pathologic diagnoses. Sixty-five questionnaires were returned (59% response rate). More than half (56%) of the respondents stated that microscopic analysis was routinely performed on all specimens, and 42% replied that only gross examination was performed, reserving microscopic examination for selected cases. Three respondents said that they discarded their specimens in the operating room. From March 1989 to October 1994, in 1985 children undergoing bilateral tonsillectomy and adenoidectomy at the Children's Hospital of Pittsburgh, no significant pathologic diagnoses were found. Twenty-seven additional children who underwent only tonsillectomy between January 1991 and October 1994 were also reviewed. One lymphoma, suspected before surgery, and a glycogen storage disorder, not suspected before surgery, were diagnosed. Therefore, in a total of 2012 children, we found only one clinically significant unsuspected diagnosis. In conclusion, we found no national consensus governing the best way to examine routine adenotonsillectomy specimens in children. Given that unsuspected diagnoses are rare, reserving microscopic analysis for specific clinical indications may be both more cost-effective and medically feasible.

Histological study of routine tonsillectomy specimen

“…To investigate the issue of histopathologic examination of routine tonsillectomy specimens, Dohar and Bonilla conducted a nationwide survey of members of the American Society of Pediatric Otolaryngology (ASPO) [15]. They received a wide range of opinions and arrived at no defi nite consensus.…”

“…However, microscopic examination of tonsil specimens generally correlates well with preoperative clinical impressions, and pathology fi ndings rarely alter patient management. Dohar and Bonilla nevertheless recommended that histopathologic evaluation be conducted routinely if only to detect rare, unsuspected malignancies [15]. Arguments in favor of microscopic examination of all tonsillectomy specimens are found in certain isolated anecdotal reports [18,19].…”

Adenotonsillar Granuloma: Histopathological Correlation

“…Routine histological examination of the tonsil and adenoid remains controversial. Missing unsuspected diagnosis such as malignancy and granulomatous disease and the medicolegal consequences are the main reasons [15,16] . Although there is no consensus regarding routine microscopic examination of the tonsils and adenoids, several studies considered that the histological examination of the tonsils and adenoids results in unnecessary cost and consumption of resources and time.…”

“…Although there is no consensus regarding routine microscopic examination of the tonsils and adenoids, several studies considered that the histological examination of the tonsils and adenoids results in unnecessary cost and consumption of resources and time. Nevertheless, examination should be reserved for selected cases, such as older patients and patients with gross asymmetry and a history of malignancy [15][16][17] . Our series demonstrates the prevalence of granulomatous afflictions of the tonsils and adenoids in otherwise healthy individuals.…”

Histopathology in Chronic Tonsillitis : A Retrospective Analysis

“…The proponents of mandatory HPE point out to accidental findings of occult carcinomas and lymphomas to propagate their espousal to the cause for HPE. 6 As a department policy at our institute all tonsils removed under the indication of Chronicity are sent for HPE. This study aims to retrospectively audit all such specimens sent over the last 3 years and document the histopathological changes occurring in the chronically inflamed tonsil and its association if any with the degree of chronicity.…”