SpringerLink
Log in

Histologie nach Tonsillektomie?

Histology after tonsillectomy?

  • Originalien
  • Published:
HNO Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Notwendigkeit der routinemäßigen histologischen Untersuchung von operativ gewonnenem Tonsillengewebe zum Ausschluss eines okkulten Malignoms wird kontrovers diskutiert.

Methoden

Die klinischen und histologischen Befunde der in unserer Klinik zwischen 01.01.2002 und 01.03.2007 tonsillektomierten Patienten wurden ausgewertet und eine Metaanalyse aller bisher veröffentlichten Studien zur histologischen Aufarbeitung von Tonsillengewebe durchgeführt. Die Häufigkeit klinisch okkulter Tonsillenmalignome wurde aufgezeigt und Kriterien für eine präoperative Risikostratifizierung bezüglich maligner Befunde ausgearbeitet. Danach erfolgte eine Kostenanalyse der histologischen Aufarbeitung aller Tonsillenpräparate.

Ergebnisse

Okkulte Tonsillenmalignome wurden bei 2 von 1523 insgesamt untersuchten Tonsillektomiepatienten (0,13%) histologisch diagnostiziert. Ausweislich der Metaanalyse 24 publizierter Studien mit insgesamt 61.550 Tonsillektomiepatienten wurden 6 okkulte Tonsillenmalignome (0,01%) beschrieben. Statistisch betrachtet müssen 7694 Tonsillenpaare histologisch untersucht werden, um ein klinisch okkultes Malignom zu detektieren; dies entspricht einem finanziellen Aufwand von etwa 385.000 EUR.

Diskussion

Unter ökonomischen Gesichtspunkten empfehlen wir die Histologie beim Vorliegen der folgenden Risikofaktoren: maligne Erkrankungen in der Anamnese, palpatorisch derbe Tonsillen, Schleimhautläsionen der Tonsillen, Tonsillenasymmetrie, Halslymphknotenschwellung, konstitutionelle Symptome, anamnestisch einseitige Beschwerden und stattgehabter Peritonsillarabszess.

Abstract

Background

The necessity to rule out clinically occult malignancies by routine histological examination of all tonsillectomy specimens is a controversial topic.

Methods

Clinical and histological findings of all patients who underwent tonsillectomy at the University of Bonn, Germany from January 2002 to March 2007 were retrospectively reviewed. A meta-analysis of PubMed literature regarding the histological results of tonsil specimens was performed. The incidence of clinically occult tonsil malignancy was recorded and potential risk factors for malignancy were analyzed. A cost-effectiveness ratio of microscopic analysis of all specimens was also performed.

Results

Clinically occult tonsil malignancies were detected in 2 out of the 1,523 patients (0.13%) in this study. In the meta-analysis of 24 studies (61,550 patients) 6 cases of clinically occult tonsil malignancies (0.01%) were identified. Statistically 7,694 tonsils have to be histologically examined to detect 1 case of occult malignancy which corresponds to an average cost per case of 385,000 EUR.

Discussion

Considering economical aspects we recommend that histological examination should be performed when the following risk factors are present: a history of cancer, tonsil firmness or lesions, tonsillar asymmetry, swelling of neck lymph nodes, constitutional symptoms, anamnestic unilateral symptoms and prior peritonsillar abscess.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Alvi A, Vartanian J (1998) Microscopic examination of routine tonsillectomy specimens: Is it necessary? Otolaryngol Head Neck Surg 119:361–363

    Article  PubMed  CAS  Google Scholar 

  2. Beaty MM, Funk GF, Karnell LH et al (1998) Risk factors for malignancy in adult tonsils. Head Neck 20:399–403

    Article  PubMed  CAS  Google Scholar 

  3. Daneshbod K, Bhutta RA, Sodagar R (1980) Pathology of tonsils and adenoids: a study of 15,120 cases. Ear Nose Throat 59:466–467

    CAS  Google Scholar 

  4. Dell’Aringa AR, Juares AJ, Melo C et al (2005) Histological analysis of tonsillectomy and adenoidectomy specimens—January 2001 to May 2003. Rev Bras Otorrinolaringol (Engl Ed) 71:18–22

    Google Scholar 

  5. Dewil B, Jorissen M, Lemkens P (2006) Routine pathological evaluation after tonsillectomy: is it necessary? B-ENT 2:103–108

    Google Scholar 

  6. Dohar JE, Bonilla JA (1996) Processing of adenoid and tonsil specimens in children: A national survey of standard practices and a five-year review of the experience at the children’s hospital of pittsburgh. Otolaryngol Head Neck Surg 115:94–97

    Article  PubMed  CAS  Google Scholar 

  7. Dost P (2006) Histologische Untersuchung nach Adenotomie und Tonsillektomie bei Kindern. HNO 54:16–19

    Article  PubMed  CAS  Google Scholar 

  8. Erdag TK, Ecevit MC, Guneri EA et al (2005) Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: Is it really necessary? Int J Pediatr Otorhinolaryngol 69:1321–1325

    Article  PubMed  Google Scholar 

  9. Erkilic S, Aydin A, Kocer NE (2002) Histological features in routine tonsillectomy specimens: the presence and the proportion of mesenchymal tissues and seromucinous glands. J Laryngol Otol 116:911–913

    Article  PubMed  Google Scholar 

  10. Felix F, Gomez GA, De Souza BP et al (2006) Evaluation of the utility of histopathologic exam as a routine in tonsillectomies. Rev Bras Otolaryngol 72:252–255

    Google Scholar 

  11. Garavello W, Romagnoli M, Sordo L et al (2004) Incidence of unexpected malignancies in routine tonsillectomy specimens in children. Laryngoscope 114:1103–1105

    Article  PubMed  Google Scholar 

  12. Ikram M, Khan MA, Ahmed M et al (2000) The histopathology of routine tonsillectomy specimens: results of a study and review of literature. Ear Nose Throat J 79:880–882

    PubMed  CAS  Google Scholar 

  13. Netser JC, Robinson RA, Smith RJ, Raab SS (1997) Value-based pathology. A cost-benefit analysis of the examination of routine and non routine tonsil and adenoid specimens. Am J Clin Pathol 108:158–165

    PubMed  CAS  Google Scholar 

  14. Randall DA, Martin PJ, Thompson LDR (2007) Routine histologic examination is unnecessary for tonsillectomy or adenoidectomy. Laryngoscope 117:1600–1604

    Article  PubMed  Google Scholar 

  15. Reiter ER, Randolph, GW, Pilch BZ (1999) Microscopic detection of occult malignancy in the adult tonsil. Otolaryngol Head Neck Surg 120:190–194

    Article  PubMed  CAS  Google Scholar 

  16. Ridgway D, Wolff LJ, Neerhout RC, Tilford DL (1987) Unsuspected non-Hodgkin’s lymphoma of the tonsils and adenoids in children. Pediatrics 79:399–402

    PubMed  CAS  Google Scholar 

  17. Sodagar R, Mohallatee EA (1972) Necessity of routine pathological examination of tonsils. Eye Ear Nose Throat Mon 51(6):229–230

    PubMed  CAS  Google Scholar 

  18. Starry A (1939) Pathology of the tonsils with statistical report and microscopic study. Ann Otol Rhinol Laryngol 48:346–358

    Google Scholar 

  19. Strong EB, Rubinstein B, Senders CW (2001) Pathologic analysis of routine tonsillectomy and adenoidectomy specimens. Otolaryngol Head Neck Surg 125:473–477

    PubMed  CAS  Google Scholar 

  20. Syms MJ, Birkmire-Peters DP, Holtel MR (2000) Incidence of carcinoma in incidental tonsil asymmetry. Laryngoscope 110:1807–1810

    Article  PubMed  CAS  Google Scholar 

  21. Weibel E (1965) Pathological findings of clinical value in tonsils and adenoids. Acta Otolaryngol 60:331–337

    Article  Google Scholar 

  22. Williams MD, Brown HM (2003) The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. Hum Pathol 34:1053–1057

    Article  PubMed  Google Scholar 

  23. Yarington CT, Smith GS, Benzmiller JA (1967) Value of histologic examination of tonsils. A report of isolated tonsillar sarcoidosis. Arch Otolaryngol 85:680–681

    PubMed  Google Scholar 

  24. Younis RT, Hesse SV, Anand VK (2001) Evaluation of the utility and cost-effectiveness of obtaining histopathologic diagnosis on all routine tonsillectomy specimens. Laryngoscope 111:2166–2169

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde/Chirurgie, Rheinische Friedrich-Wilhelms-Universität, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    A. Schrock, M. Jakob, T. Send, M. Bucheler & F. Bootz

  2. Institut für Pathologie, Rheinische Friedrich-Wilhelms-Universität, Bonn, Deutschland

    L. Heukamp

Authors
  1. A. Schrock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Jakob
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Send
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Heukamp
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Bucheler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Bootz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Schrock.

Additional information

Ergebnisse dieser Arbeit sind Teile der Dissertationsschrift von Herrn Thorsten Send.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schrock, A., Jakob, M., Send, T. et al. Histologie nach Tonsillektomie?. HNO 57, 351–357 (2009). https://doi.org/10.1007/s00106-009-1889-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-009-1889-0

Schlüsselwörter

Keywords

Search

Navigation