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.
Eur Arch Otorhinolaryngol. 2020 Jun;277(6):1779-1783. doi: 10.1007/s00405-020-05873-4. Epub 2020 Mar 4.
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.
A retrospective chart review of adult patients with UTE who underwent tonsillectomy between 1/1/2006 and 31/12/2016 was conducted.
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.
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.
扁桃体切除术适用于单侧扁桃体肿大（UTE），以排除恶性肿瘤，最终约有 1.4%的患者被发现患有恶性肿瘤。本研究旨在评估因UTE 而行扁桃体切除术的患者的临床表现，并确定与恶性肿瘤风险增加相关的参数，以便更好地评估和完善当前的治疗方案。
对 2006 年 1 月 1 日至 2016 年 12 月 31 日期间因UTE 而行扁桃体切除术的成年患者进行回顾性病历分析。
共纳入 41 例中位年龄为 53 岁的患者。其中女性 20 例（49%），男性 21 例（51%）。16 例（39%）患者被诊断为扁桃体恶性肿瘤。与良性组相比，恶性肿瘤组患者年龄更大（p=0.001），既往有恶性肿瘤病史（p=0.006），且更不可能偶然发现（p<0.001）。淋巴结肿大、咽痛、扁桃体黏膜可疑外观和硬实度在恶性肿瘤组也被发现具有统计学意义（p=0.017、p=0.001、p=0.01 和 p=0.018）。多变量回归显示年龄、外观和相邻组织受累是与恶性肿瘤独立相关的因素。
仅单侧扁桃体肿大（UTE）作为偶然发现，不应作为扁桃体切除术的指征，因为恶性肿瘤的风险较低，但发病率较高。我们建议在决策过程中整合上述临床参数，这些参数在恶性肿瘤组中更为常见。
