Can low autopsy rates be increased? Yes, we can! Should postmortem examinations in oncology be performed? Yes, we should! A postmortem analysis of oncological cases

Abstract

Ever declining autopsy rates have been a concern of pathologists as well as clinicians for decades. Notably, in the field of oncology, data on autopsies and discrepancies between clinical and autoptic diagnoses are particularly scarce. In this retrospective study, we show the effect of a simple catalog of measures consisting of a different approach to obtain consent for autopsy, structured conferencing, and systematic teaching of residents, as well as a close collaboration between clinicians and pathologists on the numbers of autopsies, especially of oncological patients. Additionally, postmortem examination protocols from the years 2015 until 2019 were analyzed, regarding rates of discrepancies between clinical and autoptic causes of death in this category of patients. Autopsy numbers could be significantly increased from a minimum in 2014 (60 autopsies) to a maximum in 2018 (142 autopsies) (p < 0.0001). In the 67 autopsies of oncological cases, a high rate of 51% of major discrepancy between clinical and autoptic causes of death could be detected. In contrast to the general reported decline of autopsy rates, we present rising autopsy numbers over the past 5 years with an increasing number of oncological cases who underwent a postmortem examination. The high percentage of major discrepancies between clinical and autopsy diagnosis is in contrast to an expected decrease of major discrepancies in times of precise diagnostic methods and underlines the importance of autopsies to ensure high quality in diagnostics and therapy not only in the field of oncology.

Cause of Death in Patients in Radiation Oncology

“…The rate of major discrepancies (37%) in our study was within reported range for oncologic patients ( 14 , 30 – 33 ). Moreover, in the observed years, a high rate in autopsy did not necessarily correlate with a low rate in major discrepancies, as reported in a large review ( 1 ).…”

“…Moreover, in the observed years, a high rate in autopsy did not necessarily correlate with a low rate in major discrepancies, as reported in a large review ( 1 ). This missing correlation was also described by Waidhauser et al ( 30 ). One reason may be the small sample size and short period of our and their study.…”

“…As a result, autopsies are offered less frequently. This claim is supported by a prospective study by Waidhauser et al (30). They demonstrated that by systematically educating residents and offering autopsy as a last medical measure, a significantly higher autopsy rate can be achieved.…”

Viral mapping in COVID-19 deceased in the Augsburg autopsy series of the first wave: A multiorgan and multimethodological approach

“…Given the high numbers of critically ill patients, it became necessary to establish an effective approach to investigate all the aspects of this new disease. Autopsy rates declined dramatically over the last decades, but it can offer the opportunity to directly inspect all organs, identify the cause of death, and generate specimens for further investigations [4]. And this is true for COVID-19 as well, a new disease still not yet understood in detail and lack of sufficient therapeutic approach.…”

The importance of autopsies despite the declining number amidst the COVID-19 pandemic

“…Reports show autopsy rates in Germany, France, Sweden, and the United States have declined by 30% or more since 2005. 10 To help programs mitigate concerns about meeting the required autopsy number during pathology residency, ACGME permits two residents to share an autopsy. 8 While this sanction aids in making the autopsy requirement more attainable for residents, concerns amplified during the COVID-19 pandemic.…”