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Is routine pathological examination required in South African children undergoing adenotonsillectomy?

Anton C van Lierop1, C A J Prescott

  • 1Division of Otolaryngology, University of Cape Town Medical School. antonvl@worldonline.co.za

South African Medical Journal = Suid-Afrikaanse Tydskrif Vir Geneeskunde
|March 12, 2010
PubMed

Insights

Routine pathological examination of tonsils and adenoids in children is not cost-effective. Specific criteria, like tuberculosis contact or HIV status, can help identify children needing further investigation for adenotonsillar abnormalities.

Area of Science:

  • Otolaryngology
  • Pediatric Pathology
  • Infectious Diseases

Background:

  • Tonsillectomy and/or adenoidectomy (T&A) are common procedures in children.
  • Pathological examination of T&A specimens is standard practice in many settings.
  • The cost-effectiveness and necessity of routine pathological examination require evaluation, especially for identifying conditions like tuberculosis.

Purpose of the Study:

  • To determine the incidence of abnormal pathological findings in pediatric tonsils and adenoids.
  • To assess the incidence of tonsillar and adenoid tuberculosis.
  • To identify risk factors for adenotonsillar tuberculosis and evaluate the cost-effectiveness of routine pathological examination.

Main Methods:

  • Prospective study of children (<=12 years) undergoing T&A.
  • Pre- and intra-operative assessment of tonsil size.
  • Histological examination of all tonsil and adenoid specimens; HIV testing performed.

Main Results:

  • 172 children (344 tonsils) analyzed; 1 case of nasopharyngeal tuberculosis and 1 lymphoma identified.
  • 7.6% of patients had clinically asymmetric tonsils without significant pathological findings.
  • Average cost to detect a clinically significant abnormality was R22,744.

Conclusions:

  • Routine pathological examination of adenotonsillectomy specimens in South African children is not cost-effective.
  • Criteria such as tuberculosis contact, systemic symptoms, lymphadenopathy, suspicious nasopharyngeal appearance, HIV status, rapid tonsillar enlargement, or asymmetry can guide selective pathological examination.
  • Selective pathological examination can improve cost-effectiveness.
Abstract

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