[Histology after tonsillectomy?].

BACKGROUND: The necessity to rule out clinically occult malignancies by routine histological examination of all tonsillectomy specimens is a controversial topic.

METHODS: Clinical and histological findings of all patients who underwent tonsillectomy at the University of Bonn, Germany from January 2002 to March 2007 were retrospectively reviewed. A meta-analysis of PubMed literature regarding the histological results of tonsil specimens was performed. The incidence of clinically occult tonsil malignancy was recorded and potential risk factors for malignancy were analyzed. A cost-effectiveness ratio of microscopic analysis of all specimens was also performed.

RESULTS: Clinically occult tonsil malignancies were detected in 2 out of the 1,523 patients (0.13%) in this study. In the meta-analysis of 24 studies (61,550 patients) 6 cases of clinically occult tonsil malignancies (0.01%) were identified. Statistically 7,694 tonsils have to be histologically examined to detect 1 case of occult malignancy which corresponds to an average cost per case of 385,000 EUR.

DISCUSSION: Considering economical aspects we recommend that histological examination should be performed when the following risk factors are present: a history of cancer, tonsil firmness or lesions, tonsillar asymmetry, swelling of neck lymph nodes, constitutional symptoms, anamnestic unilateral symptoms and prior peritonsillar abscess.