Tonsillectomy Specimen Analysis Not Cost Effective

Is pathological evaluation of routine pediatric tonsillectomy specimens necessary?

Background: Although adenotonsillectomy for hypertrophic tonsils and adenoids or chronic tonsillitis remains one of the most common procedures performed in the U.S., there is still no uniform consensus on the management of the surgical specimens. There seems, however, to be a decreasing trend over the last few years of performing microscopic or gross examination on tonsil specimens after routine tonsillectomy. To date, there has been no data on the cost-effectiveness of the different options for handling tonsillectomy specimens.

Study design: Retrospective case series.

Setting: Tertiary care children’s hospital.

Synopsis: Researchers reviewed the charts of 5,235 pediatric patients who underwent a tonsillectomy between January 1998 and December 2008, then evaluated the results of pathological evaluation of routine and non-routine specimens. According to the protocol active during this period, specimens from tonsillectomy were sent for gross examination (routine) unless specific indications (non-routine) for microscopic analysis existed. These specific indications included age older than 18 years, suspicion of malignancy, asymmetry of tonsil size, mass, history of hematolymphoid neoplasm or a history of transplantation.

Of the 5,235 tonsillectomy specimens, 4,169 underwent gross pathologic analysis only, while 1,066 underwent microscopic analysis. No pathological abnormalities were identified in the gross-only specimens. Seventeen specimens that were found to be suspicious on gross exam had no pathology after microscopic exam. Positive pathological findings on microscopic analysis were only identified in post-transplant patients and in cases of surgeon suspicion. These results are congruent with previous reports.

Bottom line: There is very low prevalence of unsuspected pathology on gross pathological analysis of routine tonsillectomy specimens. Therefore, microscopic analysis of routine tonsillectomy specimens is not cost effective.

Citation: Nelson ME, Gernon, TJ, Taylor JC, et al. Pathologic evaluation of routine pediatric tonsillectomy specimens: analysis of cost-effectiveness. Otolaryngol Head Neck Surg. 2011;144(5):778-783.

—Reviewed by Ravindhra G. Elluru, MD, PhD