PROCESSING OF ADENOID AND TONSIL SPECIMENS IN CHILDREN - A NATIONAL SURVEY OF STANDARD PRACTICES AND A 5-YEAR REVIEW OF THE EXPERIENCE AT THE CHILDRENS-HOSPITAL-OF-PITTSBURGH

The best means of pathologically examining routine tonsillectomy and a denoidectomy specimens in children remains controversial. Otolaryngolo gists fear missing an unsuspected diagnosis. However, the cost-effecti veness of microscopic analysis, given the rare incidence of unsuspecte d diagnosis, is questionable. If a significant pathologic diagnosis is missed, the medicolegal implications could be significant, A question naire was sent to 111 members of the American Society of Pediatric Oto laryngology, Additionally, we reviewed our experience at the Children' s Hospital of Pittsburgh for the 5-year span from 1989 to 1994 to dete rmine our incidence of unsuspected pathologic diagnoses, Sixty-five qu estionnaires were returned (59% response rate). More than half (56%) o f the respondents stated that microscopic analysis was routinely perfo rmed on all specimens, and 42% replied that only gross examination was performed, reserving microscopic examination for selected cases, Thre e respondents said that they discarded their specimens in the operatin g room, From March 1989 to October 1994, in 1985 children undergoing b ilateral tonsillectomy and adenoidectomy at the Children's Hospital of Pittsburgh, no significant pathologic diagnoses were found, Twenty-se ven additional children who underwent only tonsillectomy between Janua ry 1991 and October 1994 were also reviewed, One lymphoma, suspected b efore surgery, and a glycogen storage disorder, not suspected before s urgery, were diagnosed, Therefore, in a total of 2012 children, we fou nd only one clinically significant unsuspected diagnosis, In conclusio n, we found no national consensus governing the best way to examine ro utine adenotonsillectomy specimens in children, Given that unsuspected diagnoses are rare, reserving microscopic analysis for specific clini cal indications may be both more cost-effective and medically feasible .