Discontinuing routine histopathological analysis after adult tonsillectomy for benign indication
Bibliographic record
Abstract
OBJECTIVE: This study examines the rate of occult malignancy in routine histopathological analysis of tonsillectomy specimens from benign surgical cases in adults. STUDY DESIGN: Retrospective data review. METHODS: 181 consecutive charts of tonsillectomies performed for benign indications between March 2007 and March 2014 were reviewed. Data on age, indications for surgery, preoperative and intraoperative clinical findings, and final pathology results were collected. A literature review of studies examining the rate of occult malignancy in tonsillectomy specimens was also performed, and the combined data was pooled. The financial impact of routine tonsil pathological analysis was determined. RESULTS: In 181 patients, there was one case of occult malignancy. After study inclusion and exclusion criteria were met, a review of the literature yielded 3,724 pooled tonsillectomy cases, with no case of unsuspected occult malignancy reported in the literature. The number needed to screen combining our series with the reported literature was 3,904. The financial impact of routine histopathological analysis at our institution was determined to be CAD $3308 per year. CONCLUSION: Routine pathological analysis of tonsil specimens recovered from surgery performed for benign indications, in the absence of any suspicion preoperatively for malignancy, is not supported by current evidence and is not financially sound. Modern evidence does not support the need for even gross specimen analysis in these cases.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".