Diagnostic Procedures for the tonsils
The search identified 16 studies including over 2700
patients5,10-14,18-27. 11 studies documented detection
rate with tonsillectomy5,10-14,18,19-22 (table 2 &
3), 9 studies quoted the rates of synchronous tonsillar
SCC5,11,12,14,19,23-26 (not necessarily
HNSCCUP23,24) (table 4) and 3 examined the role of HPV
status in cancer detection following
tonsillectomy19,24,27 (table 5).
Deep tonsil biopsy versus tonsillectomy
Five studies investigated the efficacy of random tonsil biopsies versus
tonsillectomy5,10,11,18,19 (Table 2). The rate of
positive findings on tonsil biopsy ranged from
019-16.7%18 in these studies,
whereas positive findings on tonsillectomy ranged from
25.519-44.3%14 (table 2-5). Tanzler
et al5 recommend that random biopsies of the tonsil
have a low pickup rate and tonsillectomy should be performed instead.
Di Maio et al8 performed a large systematic review and
meta-analysis specifically addressing the role of palatine tonsillectomy
in the diagnostic workup of HNSCCUP.
Fourteen studies were included, involving 673 patients in total; 338
underwent tonsillectomy as part of examination under anaesthetic (EUA),
and 78 underwent palatine tonsillectomy as part of TORS. The study
identified 140 occult tonsil cancers. The authors performed a
meta-analysis of 11 of these studies (n670) this gave an overall
detection rate with tonsillectomy of 34% (99% confidence interval
0.23-0.46) and provides the current highest quality of evidence
supporting the role of tonsillectomy in the investigation of HNSCCUP.