Deep brush-based cytology in tonsils resected for benign diseases

Area of Science:

• Otorhinolaryngology
• Oncology
• Virology

Background:

• Oropharyngeal cancer (OPC), particularly tonsil cancer, is linked to human papillomavirus (HPV), primarily HPV16.
• Developing noninvasive diagnostic methods for tonsillar precancerous lesions, such as liquid-based cytology (LBC), is crucial.
• Precancerous lesions may be concealed within the deep tonsillar crypts, posing a diagnostic challenge.

Purpose of the Study:

• To evaluate the utility of LBC obtained by deep brushing of resected tonsils for detecting HPV and precancerous lesions.
• To assess the prevalence of HPV and cytological abnormalities in tonsillectomy patients.

Main Methods:

• Two hundred non-pediatric patients undergoing tonsillectomy were included.
• An ultra-sensitive Luminex bead-based platform was used to test for 21 mucosal HPV types.
• Cytological and histological examinations were performed on resected tonsils.

Main Results:

• 56% of LBC slides were unsatisfactory for analysis.
• 1.5% of patients showed suspicious cytological findings (ASC-H).
• Three patients tested HPV-positive (2 for HPV16, 1 for HPV39); none had dysplasia on histology.

Conclusions:

• Deep brushing of tonsils is unlikely to be a reliable in vivo method for detecting precancerous lesions.
• The low prevalence of HPV in tonsils contrasts with its higher detection rate in the oral cavity.
• Given the absence of OPC screening, emphasis should be placed on primary prevention, including HPV vaccination and lifestyle modifications.