Is routine pathological examination required in South African children undergoing adenotonsillectomy?
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.
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.
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).
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.
Anton Christiaan van Lierop,
Christopher Andrew Prescott,
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Date published: 2009-11-05
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