Is routine pathological examination required in South African children undergoing adenotonsillectomy?

Abstract

Objective

We aimed to determine the incidence of abnormal pathologic findings in the tonsils and/ or adenoids of children undergoing tonsillectomy +/- adenoidectomy; incidence of tuberculosis of the tonsils and adenoids, and suggest criteria to identify children at risk for adenotonsillar tuberculosis; association between HIV and adenotonsillar abnormality; and the cost-effectiveness of routine pathological examination of adenotonsillectomy specimens, and criteria to decide which specimens to send for histology.
Methods
This was an 8 month prospective study on all children (≤ 12 years) undergoing consecutive tonsillectomy or adenotonsillectomy (T&A) at Red Cross War Memorial Children’s’ Hospital (RCH). Patients were assessed pre-operatively and tonsil sizes graded pre- and intra-operatively. Blood was taken for HIV testing and all tonsils and adenoids had histological examinations. A cost-benefit analysis was done to determine the cost- effectiveness of adeno- tonsillectomy routine pathology.
Results
A total of 344 tonsils were analysed on 172 children (102 males, 70 females); one patient had nasopharyngeal tuberculosis and another lymphoma of the tonsils; 13 (7.6%) patients had clinically asymmetrically enlarged tonsils but no significant abnormal pathological finding. The average charge to detect a clinically significant abnormality was R22 744 (R45 488 ÷ 2 abnormalities).
Conclusions
The following criteria could improve cost-effectiveness of pathological examination of adenotonsillectomy specimens: positive tuberculosis contact in the house, systemic symptoms of fever and weight loss, cervical lymphadenopathy >3cm, suspicious nasopharyngeal appearance, HIV positive patients, rapid tonsillar enlargement or significant tonsillar asymmetry. On our evidence routine pathology on South African children does not seem to be justified.