Discontinuing Routine Histopathological Analysis After Adult Tonsillectomy for Benign Indication
Discontinuing Routine Histopathological Analysis After Adult Tonsillectomy for Benign Indication
复制标题
DOI：
10.1002/lary.25152
复制
发表时间：
2015-07-01
期刊：
影响因子：
2.6
通讯作者：
Rotenberg, Brian W.
中科院分区：
文献类型：
--
作者：
Chow, Winsion;Rotenberg, Brian W.
目的：研究成人良性手术扁桃体切除标本常规组织病理学分析中隐匿性恶性肿瘤的发生率。研究设计：回顾资料回顾。方法：对2007年3月至2014年3月间因良性指征施行的181例扁桃体切除手术的连续图表进行回顾。收集了年龄、手术适应症、术前和术中临床表现以及最终病理结果的数据。对扁桃体切除标本中的隐性恶性肿瘤发生率的研究也进行了文献综述，并合并了这些数据。结果：181例患者中，1例为隐匿性恶性肿瘤。在符合研究纳入和排除标准后，对文献的回顾产生了3,724例扁桃体联合切除术病例，文献中没有报告意外的隐匿性恶性肿瘤病例。结合我们的系列和报道的文献进行筛选所需的人数为3904人。我们机构的常规组织病理学分析的财务影响被确定为每年3308加元。结论：在术前没有任何恶性怀疑的情况下，对手术后良性指征的扁桃体标本进行常规病理分析，不能得到现有证据的支持，而且财务状况不佳。现代证据甚至不支持在这些情况下进行大体标本分析的必要性。
Objective: This study examines the rate of occult malignancy in routine histopathological analysis of tonsillectomy specimens from benign surgical cases in adults.Study Design: Retrospective data review.Methods: 181 consecutive charts of tonsillectomies performed for benign indications between March 2007 and March 2014 were reviewed. Data on age, indications for surgery, preoperative and intraoperative clinical findings, and final pathology results were collected. A literature review of studies examining the rate of occult malignancy in tonsillectomy specimens was also performed, and the combined data was pooled. The financial impact of routine tonsil pathological analysis was determined.Results: In 181 patients, there was one case of occult malignancy. After study inclusion and exclusion criteria were met, a review of the literature yielded 3,724 pooled tonsillectomy cases, with no case of unsuspected occult malignancy reported in the literature. The number needed to screen combining our series with the reported literature was 3,904. The financial impact of routine histopathological analysis at our institution was determined to be CAD $3308 per year.Conclusion: Routine pathological analysis of tonsil specimens recovered from surgery performed for benign indications, in the absence of any suspicion preoperatively for malignancy, is not supported by current evidence and is not financially sound. Modern evidence does not support the need for even gross specimen analysis in these cases.