Tonsillectomy and hematologic malignancy: Should routine pediatric tonsillectomy specimens be sent to pathology?

Routine pediatric tonsillectomy ± adenoidectomy (T ± A) is one of the most common procedures for children worldwide, accounting for approximately 2000 procedures per year at our institution. To determine the utility of pathologic analysis of routine, nonsuspicious pediatric tonsil specimens, we inve...

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Published in:International journal of pediatric otorhinolaryngology 2021-12, Vol.151, p.110924-110924, Article 110924
Main Authors: Tholen, Kaitlyn, Kalmanson, Olivia, Francom, Christian R., Prager, Jeremy D.
Format: Article
Language:English
Subjects:
Adenoidectomy
Adolescent
Child
Female
Hematologic Neoplasms - diagnosis
Hematologic Neoplasms - epidemiology
Humans
Male
Malignancy
Palatine Tonsil - surgery
Pathology
Pediatric
Retrospective Studies
Tonsillectomy
Tonsillectomy - adverse effects
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Summary:Routine pediatric tonsillectomy ± adenoidectomy (T ± A) is one of the most common procedures for children worldwide, accounting for approximately 2000 procedures per year at our institution. To determine the utility of pathologic analysis of routine, nonsuspicious pediatric tonsil specimens, we investigated the incidence of hematologic and lymphoid malignancy diagnosed at the time of or following T ± A. Retrospective review of patients 0–18 years undergoing T ± A between 2012 and 2020 with or without pathologic analysis. Included were 14,141 patients who underwent routine T ± A (mean age 11 ± 4.6 years, 48% female). Of these, tonsils of 2464 patients were sent to pathology, where zero were found to harbor malignancy. Seven patients (0.050%) developed malignancy after T ± A. Of these, 4 had unremarkable tonsils per pathology, and 3 did not have tonsils analyzed. There were 5 cases of Acute Lymphocytic Leukemia (ALL, 0.035%), 1 case of Acute Myeloid Leukemia (0.007%), and 1 case of Lymphoma (0.007%). The average length of time from T ± A to diagnosis was 2.4 ± 1.8 years. No cases of occult malignancy were identified in specimens from routine T ± A with pathologic analysis, even among patients who later developed malignancy. This study suggests that sending routine pediatric T ± A specimens for formal pathologic analysis is an inefficient use of resources without appreciably improving the quality and safety of patient care. •No cases of occult malignancy identified in routine tonsillectomy specimens.•Seven of 14,141 patients developed malignancy 2.4 ± 1.8 years after surgery.•Sending routine pediatric tonsils to pathology likely does not improve outcomes.
ISSN:0165-5876
1872-8464
DOI:10.1016/j.ijporl.2021.110924