Should paediatric tonsillar asymmetry be an indication for tonsillectomy? A single centre experience

Area of Science:

• Otolaryngology
• Pediatric Oncology
• Surgical Pathology

Background:

• Paediatric tonsillar lymphoma (TL) is rare, with clinical asymmetry often raising suspicion.
• Tonsil asymmetry may reflect fossa depth rather than true volume discrepancy, leading to diagnostic uncertainty.
• Debate exists regarding tonsillectomy necessity for asymmetry and identifying reliable lymphoma indicators.

Purpose of the Study:

• To determine if clinical tonsil asymmetry reliably indicates true tonsil volume differences.
• To evaluate clinical and examination features associated with paediatric tonsillar lymphoma.

Main Methods:

• Retrospective review of pediatric tonsil specimens (2012-2023) with lymphoma suspicion.
• Comparison of clinical asymmetry (Brodsky criteria) against pathology-reported tonsil volume.
• Analysis of patient demographics and clinical data.

Main Results:

• Three out of 143 pediatric tonsillectomies were positive for lymphoma.
• Pain and abnormal tonsil appearance significantly predicted lymphoma (p<0.02).
• Clinical size difference showed poor reliability for true volume difference (Kappa = -0.13, p<0.05).

Conclusions:

• Clinical assessment of tonsil size asymmetry is a poor predictor of actual volume differences.
• Combine visual inspection for abnormalities and palpation for lymphadenopathy with size assessment for better clinical decisions.