title: Pathologic evaluation of routine pediatric tonsillectomy specimens: analysis of cost-effectiveness.
abstract: OBJECTIVE
  Evaluate the utility and explore the cost-effectiveness of mandatory gross or pathologic analysis of routine tonsillectomy specimens in children.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Retrospective case series of results of pathologic analysis of tonsillectomy specimens from all pediatric patients who underwent tonsillectomy between 1996 and 2008 (n = 5235). The results of pathologic evaluation of routine and nonroutine specimens were evaluated, and an economic analysis of alternative methods of specimen handling was performed.
  
  
  RESULTS
  Zero cases of unsuspected pathology were identified on planned gross specimen evaluation (n = 4186), resulting in an estimated prevalence of 0 to 0.00088 (95% confidence interval [CI]). Positive pathologic findings on microscopic analysis (n = 1066) were only identified in posttransplant patients (10/63; 95% CI, 0.079-0.27) and cases of surgeon suspicion (8/78; 0.045-0.19). No cases were identified among the 17 undergoing microscopic pathologic analysis on the basis of pathologist suspicion on gross evaluation (95% CI, 0-0.20). From an economic standpoint, microscopic evaluation of routine pediatric tonsillectomy specimens appears to be superior to gross evaluation but with an estimated cost of $766,500 per case of unsuspected lymphoma identified.
  
  
  CONCLUSIONS
  This study identifies a very low prevalence of unsuspected pathology on gross pathologic analysis of routine tonsillectomy specimens in children. Exploration of the cost implications suggests that such a practice is not a cost-effective use of limited health care resources. Microscopic examination is appropriate for posttransplantation patients and in cases of surgeon suspicion.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, MI 48109- 5241, USA.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Nelson
authors.forename: T J
authors.initials: TJ
authors.lastname: Gernon
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Taylor
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: McHugh
authors.forename: Marc C
authors.initials: MC
authors.lastname: Thorne
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D006801:Humans; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery*; D010336:Pathology / Q000191:economics; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000191:economics* / Q000592:standards*