Routine pathological evaluation after tonsillectomy: is it necessary?

Routine pathological evaluation after tonsillectomy: is it necessary? Objectives: There is still no consensus regarding the necessity of sending every tonsil specimen for histological examination following tonsillectomy. To add to this discussion, we assessed the incidence of preoperatively unexpected malignancy in the postoperative tonsil specimens of adults and children in our ENT department. Methods: We conducted a retrospective study of the histopathology results of all patients who underwent tonsillectomy between January 1999 and February 2006 in the ENT department of East Limburg Hospital in Genk. The charts of patients with postoperative histopathological malignancy were further analysed and reviewed for preoperative indications of the tonsillectomy and for preoperative suspicion of malignancy. Results: A total of 2989 patients were included in the study: 2058 children (defined as 16 years or younger) and 931 adults. No malignancy was found among the children. In 20 adults, malignancy was diagnosed, but in all cases there was a preoperative suspicion of malignancy. No patient without preoperative risk factors was found to have malignancy on pathological evaluation of the tonsils. Conclusion: Our results indicate that routine histopathological examination of tonsils removed for benign disease in adults and children is clinically unnecessary. We propose that on an individual basis, the surgeon should decide the need for histological examination depending on preoperative risk factors and peroperative gross examination. Such a strategy will only be medicolegally possible where there are national and scientifically (evidence)based ENT consensus reports or guidelines on this issue.