Article record

成人和儿童无症状单侧扁桃体增大的恶性肿瘤风险：系统综述与荟萃分析

Risk of Malignancy in Asymptomatic Unilateral Tonsillar Enlargement in Adults and Children: A Systematic Review and Meta-Analysis.

综述 Meta咽喉科IF 2Q2

文献信息

PMID	42946456
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Hamad D Khan 查看其他 4 位作者 Miriam Fahmy；Azfar Javed；Ahmad K Abou-Foul；Ann-Louise McDermott
作者单位	Department of Otorhinolaryngology and Head and Neck Surgery, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK. 查看其他 3 条单位信息 Department of Otorhinolaryngology and Head and Neck Surgery, Dudley Group NHS Foundation Trust, Dudley, UK.；Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.；Institute of Head and Neck Studies and Education (InHANSE), Department of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
期刊	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
SCI 分区	Q2
IF	2
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

背景： 单侧扁桃体增大（UTE）可能引起对恶性肿瘤的担忧，并常促使进行诊断性扁桃体切除术。然而，当缺乏其他可疑特征时，其真实恶性肿瘤风险仍不确定。本研究旨在评估因孤立性无症状UTE接受扁桃体切除术的患者中恶性组织学的患病率。
方法： 按照PRISMA指南进行系统综述。检索MEDLINE、EMBASE、EMCARE、PubMed和Cochrane Library，检索时间自建库至2025年9月22日。纳入报告因孤立性无症状UTE接受扁桃体切除术患者组织病理学结局的研究。对仅成人队列进行比例荟萃分析。
结果： 共18项研究、1582份扁桃体切除标本符合纳入标准。儿童患者中未发现恶性病例（0/751；95% CI 0.00%-0.49%）。在成人患者（n = 712）中，发现6例恶性病例，均为淋巴增殖性来源。仅成人研究的荟萃分析显示合并患病率为2.04%（95% CI 0.98%-4.22%），异质性低（I2 = 15.2%）。所有队列的粗总体恶性肿瘤患病率为0.38%（95% CI 0.14%-0.82%）。
结论： 孤立性无症状UTE与极低的恶性肿瘤风险相关，尤其是在儿童患者中。常规诊断性扁桃体切除术在儿童中不太可能具有合理性，在成人中应根据临床危险因素选择性考虑。仔细的临床评估对于指导管理仍然至关重要。
试验注册： PROSPERO：CRD420261423941。

英文摘要

BACKGROUND: Unilateral tonsillar enlargement (UTE) may raise concern for malignancy and frequently prompt diagnostic tonsillectomy. However, when present in the absence of additional suspicious features, the true risk of malignancy remains uncertain. This study aimed to evaluate the prevalence of malignant histology in patients undergoing tonsillectomy for isolated asymptomatic UTE.
METHODS: A systematic review was conducted in accordance with PRISMA guidance. MEDLINE, EMBASE, EMCARE, PubMed and the Cochrane Library were searched from inception to 22 September 2025. Studies reporting histopathological outcomes in patients undergoing tonsillectomy for isolated asymptomatic UTE were included. A meta-analysis of proportions was performed for adult-only cohorts.
RESULTS: Eighteen studies comprising 1582 tonsillectomy specimens met the inclusion criteria. No malignant cases were identified in paediatric patients (0/751; 95% CI 0.00%-0.49%). Among adult patients (n = 712), six malignant cases were identified, all of which were lymphoproliferative in origin. Meta-analysis of adult-only studies demonstrated a pooled prevalence of 2.04% (95% CI 0.98%-4.22%) with low heterogeneity (I2 = 15.2%). The crude overall prevalence of malignancy across all cohorts was 0.38% (95% CI 0.14%-0.82%).
CONCLUSION: Isolated asymptomatic UTE is associated with an extremely low risk of malignancy, particularly in paediatric patients. Routine diagnostic tonsillectomy is unlikely to be justified in children and should be selectively considered in adults based on clinical risk factors. Careful clinical assessment remains essential in guiding management.
TRIAL REGISTRATION: PROSPERO: CRD420261423941.