Virginia Via Research Day Book 2026

Medical Student Research Clinical 32

PREVALENCE OF OCCULT MALIGNANCY ON HISTOPATHOLOGY OF ADULT TONSILLECTOMIES

Cara Satoskar, OMS-III; Brian Gross, MD Corresponding author: csatoskar@vcom.edu

VCOM-Virginia, Blacksburg, Virginia LewisGale Medical Center, Salem, Virginia

Context: Occult malignancy in adult tonsillectomy specimens performed for benign indications is rare, with reported rates between 0.01% and 0.15%. With the rising incidence of HPV-associated oropharyngeal squamous cell carcinoma, understanding the true prevalence of occult malignancy is important for informing clinical decision-making regarding routine histopathological examination of tonsillectomy specimens. Objective: To determine the prevalence of occult malignancy discovered on routine histopathology of adult tonsillectomy specimens performed for benign indications, and to identify patient characteristics associated with higher risk of occult malignancy. Hypothesis: We hypothesize that the prevalence of occult malignancy in adults undergoing tonsillectomy for benign indications will be between 0.01-0.15%, consistent with published literature, and that older age, smoking history, and lack of HPV vaccination will be associated with increased risk.

Methods: This retrospective cohort study will analyze de-identified data from the HCA Enterprise Data Warehouse for adult patients (age ≥18) who underwent tonsillectomy between January 2014 and present. Patients will be categorized into two groups: those with benign indications (chronic tonsillitis, tonsillar hypertrophy, sleep apnea) and those with clinical suspicion for malignancy (tonsillar asymmetry, mass, lymphadenopathy). Exclusion criteria include pre operative confirmed malignancy. The primary outcome is the prevalence of occult malignancy in the benign group, calculated using exact binomial proportion with 95% confidence intervals. Secondary analyses will examine patient characteristics associated with malignancy using conditional logistic regression with matched controls. Results: Data collection and analysis are currently in progress. Results will include the prevalence of occult malignancy in both benign and suspicious indication groups, types of malignancy identified, and risk factors associated with occult malignancy.

Conclusions: Understanding the prevalence of occult malignancy in adult tonsillectomy specimens will help inform evidence-based guidelines regarding routine histopathological examination and potentially identify high-risk patient populations who may benefit from enhanced surveillance. IRB Statement: This study was approved for IRB exemption using the HCA C.A.R.R.I.E. algorithm for de identified data analysis.

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202 Edward Via College of Osteopathic Medicine (VCOM)