Is routine pathological examination required in South African children undergoing adenotonsillectomy?
OBJECTIVE
We aimed to determine the incidence of abnormal pathological findings in the tonsils and/or adenoids of children undergoing tonsillectomy and/or adenoidectomy, and the incidence of tuberculosis of the tonsils and adenoids; suggest criteria to identify children at risk for adenotonsillar tuberculosis; and investigate the association between HIV and adenotonsillar abnormality, the cost-effectiveness of routine pathological examination of adenotonsillectomy specimens, and criteria to decide which specimens to send for histological examination.


METHODS
We undertook an 8-month prospective study on all children (< or =12 years) undergoing consecutive tonsillectomy or adenotonsillectomy (T&A) at Red Cross War Memorial Children's Hospital. Patients were assessed pre-operatively and tonsil sizes graded pre- and intra-operatively. Blood was taken for HIV testing, and all tonsils and adenoids were examined histologically. A cost-benefit analysis was done to determine the cost-effectiveness of adenotonsillectomy routine pathology.


RESULTS
A total of 344 tonsils were analysed from 172 children (102 boys, 70 girls); 1 patient had nasopharyngeal tuberculosis, and 1 lymphoma of the tonsils; 13 (7.6%) patients had clinically asymmetrically enlarged tonsils but no significant abnormal pathological finding. The average cost of detecting 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 at home, systemic symptoms of fever and weight loss, cervical lymphadenopathy >3 cm, suspicious nasopharyngeal appearance, HIV-positive patient, rapid tonsillar enlargement or significant tonsillar asymmetry. On our evidence, routine pathological investigation for South African children does not seem to be justified.
van Lierop
Anton C
AC
Division of Otolaryngology, University of Cape Town Medical School. antonvl@worldonline.co.za
Prescott
C A J
CA
D000233:Adenoidectomy / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D011446:Prospective Studies; D013019:South Africa; D014068:Tonsillectomy / Q000191:economics*; D014069:Tonsillitis / Q000473:pathology*; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000473:pathology*