Occult Malignancy in Adult Tonsillectomy for Benign Indication

Area of Science:

• Otolaryngology
• Surgical Pathology
• Oncology

Background:

• National guidelines mandate full pathology analysis for adult tonsillectomy specimens.
• Occult malignancy in adult tonsillectomy presents a diagnostic challenge.

Purpose of the Study:

• To evaluate data on occult malignancy in adult tonsillectomy performed for benign indications.
• To develop a screening system to identify patients who may not require routine histopathologic examination.

Main Methods:

• Systematic literature review of case series on adult tonsillectomy.
• Retrospective chart review of tonsillectomy cases from 2000-2016.
• Pooled analysis to determine occult malignancy prevalence and develop risk criteria.

Main Results:

• Combined data from literature and institutional review included 12,094 cases.
• Occult malignancy prevalence was 0.033% (4 cases).
• Proposed criteria would have identified 3 of 4 occult malignancies preoperatively; predicted incidence in negative cases is 0.01%.

Conclusions:

• A proposed screening criteria set can identify adult tonsillectomy patients with a low incidence of occult malignancy.
• This may allow for the safe discontinuation of routine pathologic analysis in selected cases.
• The incidence in the low-risk group is comparable to that in pediatric tonsillectomy.