Autopsy as a Quality Control Measure for Radiology, and Vice Versa

Murken, Douglas R.; Ding, Meichun; Branstetter, Barton F.; Nichols, Larry

doi:10.2214/ajr.11.8386

Cited by 21 publications

(24 citation statements)

References 8 publications

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“…The autopsy should, therefore, continue to be viewed as the ultimate tool for assessing the accuracy and risk of any diagnostic test. However, most published research investigating the autopsy as a quality assurance tool for specific types of clinical tests focuses on comparisons to medical imaging . In this study, we sought to compare post‐mortem findings to pre‐mortem FNA diagnoses.…”

Section: Discussionmentioning

confidence: 99%

“…However, most published research investigating the autopsy as a quality assurance tool for specific types of clinical tests focuses on comparisons to medical imaging. 21,22 In this study, we sought to compare postmortem findings to pre-mortem FNA diagnoses. To do so, we conducted a retrospective search of our institutional database and compared diagnoses in all patients who received an FNA, died within 30 d of the procedure, and were autopsied.…”

Section: Discussionmentioning

confidence: 99%

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Death within 30 days of fine needle aspiration: Post‐mortem confirmation of FNA diagnoses and the contribution of FNA to patient mortality

Priemer

Berry

Hawley

et al. 2018

Diagnostic Cytopathology

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Background Fine needle aspiration (FNA) diagnoses are usually confirmed via surgical pathology or via evaluation of clinical outcomes. However, such confirmation may not occur for patients who die shortly after FNA, and autopsy may be a useful quality assessment tool in these cases. Also, there is little data investigating the relationship between FNA and mortality. We sought to demonstrate the autopsy as a quality assessment tool for the FNA and assess the contribution of FNA to mortality in patients who die soon after the procedure. Methods A search of our database was performed from 1992 to 2016 for patients who were autopsied after dying within 30 d of an FNA. Concordance between findings from FNA, autopsy, and any intervening surgical pathology material was determined. Finally, a subjective determination of the likelihood that FNAs contributed to deaths was made by reviewing autopsy reports. The contribution was categorised as either “unlikely”, “possible”, or “probable”. Results Fifty‐eight patients (average age = 58 y) met the search criteria. Thirty‐six (62%) patients had malignancies. Surgical pathology material was obtained concurrently or following FNA in 20 cases (34%). There was 73% concordance between FNA and autopsy findings, which compares to 80% concordance between FNA and surgical pathology diagnoses. The FNA was determined to be at least possibly contributory to death in 7/58 cases (3 cases designated as “probable,” and 4 as “possible”). Conclusion Autopsy can be used to validate FNA diagnoses and, like surgical pathology, confirms that FNA diagnoses are mostly accurate. However, in a small number of patients, FNA can precipitate death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Death within 30 days of fine needle aspiration: Post‐mortem confirmation of FNA diagnoses and the contribution of FNA to patient mortality

Priemer

Berry

Hawley

et al. 2018

Diagnostic Cytopathology

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“…In spite of the advanced diagnostic technologies used in modern medicine, there are still discrepancies found between clinical diagnoses and post-mortem findings [3–5] with a significant rate of class-I-discrepancies (major diagnoses) [6]. By identifying these, the autopsy improves the accuracy of both death certificates [7] and epidemiologic databases [8].…”

Section: Introductionmentioning

confidence: 99%

Autopsy rates in the Netherlands: 35 years of decline

Blokker

Weustink²,

Hunink

et al. 2017

PLoS ONE

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ObjectiveAlthough the autopsy still is a valuable tool in health statistics, health care quality control, medical education, and biomedical research, autopsy rates have been declining worldwide. The aim of this study was to examine trends of overall, clinical and forensic autopsy rates among adults in the Netherlands over the last four decades, and trends per sex, age (groups), and hospital type.MethodsWe performed a retrospective study covering 35 years of Dutch national death counts (1977–2011), the number of in-hospital deceased patients, the number of deaths due to external causes, and the proportion of autopsies performed in these populations. The effects of sex, age and hospital category were analysed by linear and logistic regression and differences were evaluated by chi-square tests.ResultsOverall autopsy rates declined by 0.3% per calendar year, clinical autopsy rates by 0.7% per calendar year (from 31.4% to 7.7%), and forensic autopsy rates did not decline. Per calendar year the fraction of in-hospital deceased patients decreased by 0.2%. Autopsy rates were highest among men and younger patients; clinical autopsy rates were highest for patients dying in academic hospitals.ConclusionsIn the Netherlands clinical autopsy rates have rapidly declined while at the same time the fraction of in-hospital deaths decreased, both contributing to the overall reduced absolute number of autopsies performed. It is important to improve awareness among both clinicians and general practitioners of the significance of the clinical autopsy.

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“…A recent topic of interest in forensic radiology is post-mortem imaging using computed tomography (CT) [1][2][3][4][5]. Because postmortem biological conditions are different from antemortem conditions, antemortem and postmortem CT findings differ, leading to potential difficulties in distinguishing normal postmortem changes from those associated with the individual's pathology [1,[3][4][5][6][7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Time-related course of pleural space fluid collection and pulmonary aeration on postmortem computed tomography (PMCT)

et al. 2015

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Postmortem CT (PMCT) is increasingly used in forensic practice, and knowledge and classification of typical postmortem imaging findings would facilitate the interpretation of PMCT. The goal of this study was to define the time-related course of postmortem chest findings. Twelve cadavers (eight male, four female, 27-81 [mean, 60.0]years) were examined twice by PMCT within an interval of time (4-164 h [mean, 30.8; median, 17.5]). The pleural-space-fluid volume, pulmonary parenchyma volume, decreased aerated lung volume (DLV), %DLV (=DLV/pulmonary parenchyma volume) and chest cavity volume were compared between the first and second PMCT examinations. To evaluate the volume change rate, the rate of increase in pleural space fluid volume (mL/h) and the DLV rate (mL/h) were plotted according to the postmortem period. On the second PMCT, the volume of pleural space fluid (p=0.0469) and %DLV (p=0.0161) were significantly increased. The increase rate of the pleural space fluid increased at approximately 30 h and the volume continued to increase until approximately 40 h after death. The rate of DLV constantly decreased in the early postmortem period. In conclusion, the pleural-space-fluid collection and the DLV increased over different time-related courses in the postmortem period.

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Autopsy as a Quality Control Measure for Radiology, and Vice Versa

Cited by 21 publications

References 8 publications

Death within 30 days of fine needle aspiration: Post‐mortem confirmation of FNA diagnoses and the contribution of FNA to patient mortality

Death within 30 days of fine needle aspiration: Post‐mortem confirmation of FNA diagnoses and the contribution of FNA to patient mortality

Autopsy rates in the Netherlands: 35 years of decline

Time-related course of pleural space fluid collection and pulmonary aeration on postmortem computed tomography (PMCT)

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