Optimal utilization of histopathologic analysis of tonsil and adenoid specimens in the pediatric population

Objective: To evaluate the optimal utilization of histopathologic analysis of tonsil and adenoid specimens in the pediatric population. Methods: A retrospective review was performed on 7837 tonsil and adenoid specimens submitted from January 2004 to April 2008. The records were reviewed for the patients' age, sex, and pathologic analysis. The time and cost per analysis of each specimen were determined. Results: Histopathology was performed on 347 specimens based on clinical suspicion by the surgeon, a difference of 0.5 cm or more among tonsils, gross abnormalities, and history of malignancy, transplant, or immunocompromise. Malignancy was diagnosed in 0.026% of patients. Post-transplant lymphoproliferative disease was diagnosed in 6 of 24 immunocompromised patients. The use of these criteria resulted in a savings of $518,088.47 and 461 h of dedicated technician time per year. Conclusions: Histologic examinations in selected specimens should be based on specific criteria that should be determined by each hospital based on hospital size, finances and input from their pathologists and otolaryngogists. Storage of a representative specimen for possible retrospective review may be useful.