Occult Malignancy in Adult Tonsillectomy for Benign Indication
Objective: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine hi...
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| Veröffentlicht in: | Annals of otology, rhinology & laryngology rhinology & laryngology, 2021-04, Vol.130 (4), p.356-362 |
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| creator | Syme, Noah Brettfeld, Stefan Dorneden, Ashley Samedi, Von Bocklage, Therese Myers, Orrin Herzon, Fred Meiklejohn, Duncan A. |
| description | Objective:
National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued.
Study design:
Retrospective chart review and systematic review of the literature.
Setting:
Tertiary care academic hospital and multi-hospital private healthcare system.
Subjects and methods:
A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated.
Results:
Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000.
Conclusion:
Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens.
Level of Evidence:
Pooled analysis of case series from the literature and a single institution, level 4. |
| doi_str_mv | 10.1177/0003489420952474 |
| format | Article |
| fullrecord | <record><control><sourceid>sage_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1177_0003489420952474</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0003489420952474</sage_id><sourcerecordid>10.1177_0003489420952474</sourcerecordid><originalsourceid>FETCH-LOGICAL-c257t-16a6e95785b3603ed69d15282787c477d138c359ac8ff9a4e6bc4463c63d16153</originalsourceid><addsrcrecordid>eNp1UMtKw0AUHUSxsbp3JfmB0Xk_NkItPgqVbiq4C5OZSUlJJiWTLPL3JkRdCK4u554HnAPALUb3GEv5gBCiTGlGkOaESXYGEqwZhVySz3OQTDSc-AW4ivE4QsYRuQQLShRDmMgEPO6s7asufTdVeQgm2CEtQ7py02_fhFhWlbddUw9p0bTpkw-jKt0EV1rTlU24BheFqaK_-b5L8PHyvF-_we3udbNebaElXHYQCyO85lLxnApEvRPaYU4UkUpaJqXDVFnKtbGqKLRhXuSWMUGtoA4LzOkSoDnXtk2MrS-yU1vWph0yjLJpiuzvFKPlbrac-rz27tfw030UwFkQzcFnx6Zvw1jh_8AvFfNkmQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Occult Malignancy in Adult Tonsillectomy for Benign Indication</title><source>Access via SAGE</source><source>MEDLINE</source><creator>Syme, Noah ; Brettfeld, Stefan ; Dorneden, Ashley ; Samedi, Von ; Bocklage, Therese ; Myers, Orrin ; Herzon, Fred ; Meiklejohn, Duncan A.</creator><creatorcontrib>Syme, Noah ; Brettfeld, Stefan ; Dorneden, Ashley ; Samedi, Von ; Bocklage, Therese ; Myers, Orrin ; Herzon, Fred ; Meiklejohn, Duncan A.</creatorcontrib><description>Objective:
National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued.
Study design:
Retrospective chart review and systematic review of the literature.
Setting:
Tertiary care academic hospital and multi-hospital private healthcare system.
Subjects and methods:
A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated.
Results:
Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000.
Conclusion:
Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens.
Level of Evidence:
Pooled analysis of case series from the literature and a single institution, level 4.</description><identifier>ISSN: 0003-4894</identifier><identifier>EISSN: 1943-572X</identifier><identifier>DOI: 10.1177/0003489420952474</identifier><identifier>PMID: 32840127</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Biopsy - methods ; Humans ; Incidence ; Neoplasms, Unknown Primary - diagnosis ; Neoplasms, Unknown Primary - epidemiology ; Neoplasms, Unknown Primary - pathology ; Palatine Tonsil - pathology ; Palatine Tonsil - surgery ; Tonsillar Neoplasms - diagnosis ; Tonsillar Neoplasms - epidemiology ; Tonsillar Neoplasms - pathology ; Tonsillectomy - methods ; Tonsillectomy - statistics & numerical data ; Tonsillitis - surgery ; Unnecessary Procedures - methods</subject><ispartof>Annals of otology, rhinology & laryngology, 2021-04, Vol.130 (4), p.356-362</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c257t-16a6e95785b3603ed69d15282787c477d138c359ac8ff9a4e6bc4463c63d16153</cites><orcidid>0000-0002-7953-1765</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0003489420952474$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0003489420952474$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32840127$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Syme, Noah</creatorcontrib><creatorcontrib>Brettfeld, Stefan</creatorcontrib><creatorcontrib>Dorneden, Ashley</creatorcontrib><creatorcontrib>Samedi, Von</creatorcontrib><creatorcontrib>Bocklage, Therese</creatorcontrib><creatorcontrib>Myers, Orrin</creatorcontrib><creatorcontrib>Herzon, Fred</creatorcontrib><creatorcontrib>Meiklejohn, Duncan A.</creatorcontrib><title>Occult Malignancy in Adult Tonsillectomy for Benign Indication</title><title>Annals of otology, rhinology & laryngology</title><addtitle>Ann Otol Rhinol Laryngol</addtitle><description>Objective:
National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued.
Study design:
Retrospective chart review and systematic review of the literature.
Setting:
Tertiary care academic hospital and multi-hospital private healthcare system.
Subjects and methods:
A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated.
Results:
Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000.
Conclusion:
Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens.
Level of Evidence:
Pooled analysis of case series from the literature and a single institution, level 4.</description><subject>Adult</subject><subject>Biopsy - methods</subject><subject>Humans</subject><subject>Incidence</subject><subject>Neoplasms, Unknown Primary - diagnosis</subject><subject>Neoplasms, Unknown Primary - epidemiology</subject><subject>Neoplasms, Unknown Primary - pathology</subject><subject>Palatine Tonsil - pathology</subject><subject>Palatine Tonsil - surgery</subject><subject>Tonsillar Neoplasms - diagnosis</subject><subject>Tonsillar Neoplasms - epidemiology</subject><subject>Tonsillar Neoplasms - pathology</subject><subject>Tonsillectomy - methods</subject><subject>Tonsillectomy - statistics & numerical data</subject><subject>Tonsillitis - surgery</subject><subject>Unnecessary Procedures - methods</subject><issn>0003-4894</issn><issn>1943-572X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UMtKw0AUHUSxsbp3JfmB0Xk_NkItPgqVbiq4C5OZSUlJJiWTLPL3JkRdCK4u554HnAPALUb3GEv5gBCiTGlGkOaESXYGEqwZhVySz3OQTDSc-AW4ivE4QsYRuQQLShRDmMgEPO6s7asufTdVeQgm2CEtQ7py02_fhFhWlbddUw9p0bTpkw-jKt0EV1rTlU24BheFqaK_-b5L8PHyvF-_we3udbNebaElXHYQCyO85lLxnApEvRPaYU4UkUpaJqXDVFnKtbGqKLRhXuSWMUGtoA4LzOkSoDnXtk2MrS-yU1vWph0yjLJpiuzvFKPlbrac-rz27tfw030UwFkQzcFnx6Zvw1jh_8AvFfNkmQ</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Syme, Noah</creator><creator>Brettfeld, Stefan</creator><creator>Dorneden, Ashley</creator><creator>Samedi, Von</creator><creator>Bocklage, Therese</creator><creator>Myers, Orrin</creator><creator>Herzon, Fred</creator><creator>Meiklejohn, Duncan A.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><orcidid>https://orcid.org/0000-0002-7953-1765</orcidid></search><sort><creationdate>202104</creationdate><title>Occult Malignancy in Adult Tonsillectomy for Benign Indication</title><author>Syme, Noah ; Brettfeld, Stefan ; Dorneden, Ashley ; Samedi, Von ; Bocklage, Therese ; Myers, Orrin ; Herzon, Fred ; Meiklejohn, Duncan A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c257t-16a6e95785b3603ed69d15282787c477d138c359ac8ff9a4e6bc4463c63d16153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Biopsy - methods</topic><topic>Humans</topic><topic>Incidence</topic><topic>Neoplasms, Unknown Primary - diagnosis</topic><topic>Neoplasms, Unknown Primary - epidemiology</topic><topic>Neoplasms, Unknown Primary - pathology</topic><topic>Palatine Tonsil - pathology</topic><topic>Palatine Tonsil - surgery</topic><topic>Tonsillar Neoplasms - diagnosis</topic><topic>Tonsillar Neoplasms - epidemiology</topic><topic>Tonsillar Neoplasms - pathology</topic><topic>Tonsillectomy - methods</topic><topic>Tonsillectomy - statistics & numerical data</topic><topic>Tonsillitis - surgery</topic><topic>Unnecessary Procedures - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Syme, Noah</creatorcontrib><creatorcontrib>Brettfeld, Stefan</creatorcontrib><creatorcontrib>Dorneden, Ashley</creatorcontrib><creatorcontrib>Samedi, Von</creatorcontrib><creatorcontrib>Bocklage, Therese</creatorcontrib><creatorcontrib>Myers, Orrin</creatorcontrib><creatorcontrib>Herzon, Fred</creatorcontrib><creatorcontrib>Meiklejohn, Duncan A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Annals of otology, rhinology & laryngology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Syme, Noah</au><au>Brettfeld, Stefan</au><au>Dorneden, Ashley</au><au>Samedi, Von</au><au>Bocklage, Therese</au><au>Myers, Orrin</au><au>Herzon, Fred</au><au>Meiklejohn, Duncan A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Occult Malignancy in Adult Tonsillectomy for Benign Indication</atitle><jtitle>Annals of otology, rhinology & laryngology</jtitle><addtitle>Ann Otol Rhinol Laryngol</addtitle><date>2021-04</date><risdate>2021</risdate><volume>130</volume><issue>4</issue><spage>356</spage><epage>362</epage><pages>356-362</pages><issn>0003-4894</issn><eissn>1943-572X</eissn><abstract>Objective:
National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued.
Study design:
Retrospective chart review and systematic review of the literature.
Setting:
Tertiary care academic hospital and multi-hospital private healthcare system.
Subjects and methods:
A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated.
Results:
Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000.
Conclusion:
Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens.
Level of Evidence:
Pooled analysis of case series from the literature and a single institution, level 4.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>32840127</pmid><doi>10.1177/0003489420952474</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-7953-1765</orcidid></addata></record> |
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| ispartof | Annals of otology, rhinology & laryngology, 2021-04, Vol.130 (4), p.356-362 |
| issn | 0003-4894 1943-572X |
| language | eng |
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| source | Access via SAGE; MEDLINE |
| subjects | Adult Biopsy - methods Humans Incidence Neoplasms, Unknown Primary - diagnosis Neoplasms, Unknown Primary - epidemiology Neoplasms, Unknown Primary - pathology Palatine Tonsil - pathology Palatine Tonsil - surgery Tonsillar Neoplasms - diagnosis Tonsillar Neoplasms - epidemiology Tonsillar Neoplasms - pathology Tonsillectomy - methods Tonsillectomy - statistics & numerical data Tonsillitis - surgery Unnecessary Procedures - methods |
| title | Occult Malignancy in Adult Tonsillectomy for Benign Indication |
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