Tonsillectomy and hematologic malignancy: Should routine pediatric tonsillectomy specimens be sent to pathology?

Area of Science:

• Pediatric Otolaryngology
• Hematologic Oncology
• Surgical Pathology

Background:

• Tonsillectomy ± adenoidectomy (T ± A) is a common pediatric surgical procedure.
• Pathologic analysis of routine T ± A specimens is standard practice.
• The utility of this analysis for detecting occult malignancy is questioned.

Purpose of the Study:

• To determine the diagnostic yield of routine pathologic analysis of pediatric tonsil specimens.
• To investigate the incidence of hematologic and lymphoid malignancy in children undergoing T ± A.

Main Methods:

• Retrospective review of 14,141 pediatric patients (0-18 years) undergoing T ± A between 2012 and 2020.
• Analysis of tonsil specimens sent for pathology versus those not analyzed.
• Correlation with subsequent malignancy diagnoses.

Main Results:

• Zero malignancies were identified in 2,464 tonsil specimens analyzed.
• Seven patients (0.050%) were diagnosed with malignancy post-T ± A.
• Malignancies included Acute Lymphocytic Leukemia (ALL), Acute Myeloid Leukemia, and Lymphoma.

Conclusions:

• Routine pathologic analysis of pediatric T ± A specimens does not identify occult malignancies.
• Pathologic analysis of these specimens is an inefficient use of resources.
• Current practice does not significantly improve patient care quality or safety.