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Clinical parameters predicting tonsillar malignancy

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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Tonsillectomy is indicated in unilateral tonsillar enlargement (UTE) to rule out malignancy, which eventually is found in about 1.4% of the patients. The aim of this study was to evaluate the presenting symptoms of patients who underwent tonsillectomy for UTE and identify parameters that are associated with an increased risk for malignancy, for better assessment and refinement of current management protocols.

Methods

A retrospective chart review of adult patients with UTE who underwent tonsillectomy between 1/1/2006 and 31/12/2016 was conducted.

Results

Forty-one patients with a median age of 53 years were included. There were 20 (49%) females and 21 (51%) males. Sixteen (39%) patients were diagnosed as having tonsillar malignancy. Patients with malignancy were older than those in the benign group (p = 0.001), had a previous malignancy (p = 0.006), and were less likely to present as an incidental finding (p < 0.001). Lymphadenopathy, throat pain, suspicious appearance of tonsillar mucosa, and hard consistency were also found to be statistically significant findings in the malignancy group (p = 0.017, p = 0.001, p = 0.01 and p = 0.018, respectively). Multivariable regression showed age, appearance and adjacent tissue involvement to be independently with malignancy.

Conclusions

UTE alone, as an incidental finding, should not be regarded as an indication for tonsillectomy, as the risk for malignancy is low and the morbidity is significant. We suggest integrating the above-mentioned clinical parameters in the decision-making process, which were found to be significantly more frequent in the malignant group.

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Acknowledgements

We thank Dr. Yuval Mizrakli for his help with the statistical analysis.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Shamir (Assaf Harofeh) Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 70300, Zerifin, Israel

    Avital Fellner, Haim Gavriel, Jacob Pitaro & Limor Muallem Kalmovich

Authors
  1. Avital Fellner
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  2. Haim Gavriel
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  3. Jacob Pitaro
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  4. Limor Muallem Kalmovich
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Correspondence to Avital Fellner.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Shamir Medical Center (#0185–17-ASF). As this is a retrospective study with no intervention, an informed consent waiver was granted by the Helsinki Institutional Review Board.

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Fellner, A., Gavriel, H., Pitaro, J. et al. Clinical parameters predicting tonsillar malignancy. Eur Arch Otorhinolaryngol 277, 1779–1783 (2020). https://doi.org/10.1007/s00405-020-05873-4

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  • DOI: https://doi.org/10.1007/s00405-020-05873-4

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