Malignancy in routine tonsillectomy specimens: a systematic literature review

The aim of this systematic literature review was to investigate the prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens and to discuss whether histological examination is indicated in tonsillectomy specimens from patients without well-defined risk factors. PRISMA 2009 guidelines were considered and applied whenever possible. Articles on prevalence of unsuspected tonsillar malignancy in routine tonsillectomy specimens were selected. Unsuspected tonsillar malignancy was defined as a malignant histological diagnosis after routine tonsillectomy without the presence of the following risk factors: tonsillar asymmetry, visible lesion, tonsillar firmness, cervical adenopathy, unexpected weight loss and constitutional symptoms, history of malignancy, previous radiotherapy, or immunodeficiency. We identified 37 articles comprising 72,322 patients. A total of 11 patients (0.015 %) had unsuspected malignancy. Considering the adult population only, 12 studies including 6,434 patients were identified. Three patients (0.05 %) had unsuspected malignancy. Regarding paediatric data, 21 studies including 21,223 children were identified. Three children (0.01 %) had unsuspected malignancy. The rarity of unsuspected malignancy in clinically benign tonsils fails to provide adequate justification for routine histological examination. National guidelines or statements by ENT societies are warranted.