Histology after tonsillectomy?
Histology after tonsillectomy?
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DOI：
10.1007/s00106-009-1889-0
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发表时间：
2009-04-01
期刊：
影响因子：
0.9
通讯作者：
Bootz, F.
中科院分区：
文献类型：
--
作者：
Schrock, A.;Jakob, M.;Bootz, F.
通过对所有扁桃体切除标本进行常规组织学检查来排除临床隐匿性恶性肿瘤的必要性是一个有争议的话题。对2002年1月至2007年3月在德国波恩大学接受扁桃体切除术的所有患者的临床和组织学结果进行回顾性分析。对 PubMed 文献中有关扁桃体标本组织学结果的荟萃分析进行了。记录临床隐匿性扁桃体恶性肿瘤的发生率并分析潜在的恶性肿瘤危险因素。还对所有标本进行了显微分析的成本效益比。在本研究的 1,523 名患者中，有 2 名患者 (0.13%) 检测出临床隐匿性扁桃体恶性肿瘤。在 24 项研究（61,550 名患者）的荟萃分析中，发现了 6 例临床隐匿性扁桃体恶性肿瘤（0.01%）。据统计，需要对 7,694 个扁桃体进行组织学检查才能发现 1 例隐匿性恶性肿瘤，相当于每例平均费用为 385,000 欧元。考虑到经济方面，我们建议在存在以下危险因素时进行组织学检查：癌症病史、扁桃体硬度或病变、扁桃体不对称、颈部淋巴结肿胀、全身症状、记忆性单侧症状和既往史扁桃体周围脓肿。
The necessity to rule out clinically occult malignancies by routine histological examination of all tonsillectomy specimens is a controversial topic.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.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.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.