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.