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

• Published in: South African medical journal Vol. 99; no. 11; pp. 805 - 809
• Main Authors: VAN LIEROP, Anton C, PRESCOTT, C. A. J
• Format: Journal Article
• Language: English
• Published: Rondebosch Health and Medical Publishing Group 01.11.2009; Health & Medical Publishing Group
• Subjects: Adenoidectomy - economics; Biological and medical sciences; Care and treatment; Child; Child, Preschool; Children; Cost-Benefit Analysis; Developing Countries; Diagnosis; Female; General aspects; Health aspects; HIV Infections - complications; HIV Infections - diagnosis; HIV Infections - pathology; Human immunodeficiency virus; Humans; Infant; Male; Medical sciences; Mycobacterium; Patient outcomes; Patient Selection; Prospective Studies; South Africa; Tonsillectomy; Tonsillectomy - economics; Tonsillitis; Tonsillitis - pathology; Tuberculosis, Lymph Node - complications; Tuberculosis, Lymph Node - pathology; South Africa; Africa; Human; Tropical medicine; Child
• ISSN: 0256-9574

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. 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. 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). 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.