常规扁桃体病理检查很少发现意外恶性肿瘤：一家安全网医院的经验

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中文摘要

目的： 随着隐匿性恶性肿瘤罕见，扁桃体切除标本的常规病理检查已减少，但其在安全网环境中的价值尚未被研究。我们描述了在此环境中术前临床评估作为分诊工具的作用以及隐匿性恶性肿瘤的发生率。
方法： 这项回顾性队列研究纳入了2022年1月至2025年6月在一家大型美国安全网医院因任何指征接受扁桃体切除术的所有患者。对病理报告进行恶性肿瘤筛查；恶性病例接受病历审查，以获取人口统计学资料、Charlson合并症指数（CCI）和术前评估，并分层为预期（活检证实）、疑似（临床或影像学担忧但无组织学诊断）或意外（术前无担忧）。采用卡方检验和Mann-Whitney U检验比较各层的恶性肿瘤类型和CCI。
结果： 在769份标本中（307份儿科，462份成人），未发现儿科恶性肿瘤（0%；95% CI，0%-1.19%）。发生20例成人恶性肿瘤：13例鳞状细胞癌，7例血液系统恶性肿瘤。作为头颈肿瘤转诊中心，该队列包括因已知或疑似恶性肿瘤而进行的扁桃体切除术；20例中有19例（95%）在术前为预期或疑似。1例套细胞淋巴瘤为意外发现，占成人标本的0.22%（1/462；95% CI，0.005%-1.20%），占443例无术前担忧而切除标本的0.23%（0.006%-1.25%）。术前风险类别与恶性肿瘤类型（p = 0.41）或CCI（p = 0.37）无关。
结论： 未发现儿科恶性肿瘤，且95%的成人恶性肿瘤在术前已被预期。尽管安全网人群的癌症风险特征较高，术前临床评估作为分诊工具表现良好，支持风险分层的病理方案。在此样本量下，发生率估计不精确。

英文摘要

OBJECTIVE: Routine pathological examination of tonsillectomy specimens has declined as occult malignancy is rare, but its value in safety-net settings is unstudied. We characterized preoperative clinical assessment as a triage instrument, and occult malignancy incidence, in this setting.
METHODS: This retrospective cohort study included all patients undergoing tonsillectomy for any indication at a large US safety-net hospital from January 2022 to June 2025. Pathology reports were screened for malignancy; malignant cases underwent chart review for demographics, Charlson Comorbidity Index (CCI), and preoperative assessment, stratified as expected (biopsy-proven), suspected (clinical or radiographic concern without tissue diagnosis), or unexpected (no preoperative concern). Chi-square and Mann-Whitney U tests compared malignancy type and CCI across strata.
RESULTS: Of 769 specimens (307 pediatric, 462 adult), no pediatric malignancies were identified (0%; 95% CI, 0%-1.19%). Twenty adult malignancies occurred: 13 squamous cell carcinoma, 7 hematologic. As a head and neck oncology referral center, the cohort includes tonsillectomies for known or suspected malignancy; 19 of 20 (95%) were expected or suspected preoperatively. One mantle cell lymphoma was unexpected, comprising 0.22% of adult specimens (1/462; 95% CI, 0.005%-1.20%) and 0.23% of 443 resected without preoperative concern (0.006%-1.25%). Preoperative risk category was not associated with malignancy type (p = 0.41) or CCI (p = 0.37).
CONCLUSION: No pediatric malignancies were identified, and 95% of adult malignancies were preoperatively anticipated. Despite the elevated cancer risk profile of safety-net populations, preoperative clinical assessment performed well as a triage tool, supporting risk-stratified pathology protocols. Incidence estimates were imprecise at this sample size.