Evaluation of the discrepancy between clinical diagnostic hypotheses and anatomopathological diagnoses resulting from autopsies

Zerbini, Talita; Singer, Júlio M.; Leyton, Vilma

doi:10.6061/clinics/2019/e1197

Cited by 6 publications

(5 citation statements)

References 20 publications

(20 reference statements)

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“…Gender and age of decedents did not play a role for the frequency of major discrepancies in our study. Previous studies come to different results when regarding the influence of gender and age on the rate of discrepancies [9,14,18,22,23]. When a difference in the frequency of discrepancies was detected, more discrepancies were found in older patients and in women [14,22,23].…”

Section: Relevance Of Autopsies In Oncological Patientsmentioning

confidence: 93%

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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

Waidhauser¹,

Martin²,

Trepel³

et al. 2020

Virchows Arch

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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.

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Section: Relevance Of Autopsies In Oncological Patientsmentioning

confidence: 93%

“…In the subsequent almost 30 years, medical progress has accelerated considerably. In recent publications however, the rate of major discrepancies remains considerably high with 19.5-28% [3,[9][10][11]. In oncological patients, detailed studies of postmortem examinations are lacking.…”

Section: Introductionmentioning

confidence: 99%

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

Waidhauser¹,

Martin²,

Trepel³

et al. 2020

Virchows Arch

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“…The autopsy can provide significant insight into disease progression and treatment efficacy, and establishing an accurate cause of death ensures that reliable mortality statistics are available for public health planning. Despite advances in antemortem diagnostic techniques and postmortem imaging, clinicopathological discrepancies have remained high 1–4 . Certain pathological features are only visible microscopically and gross examination of organs is fallible: histopathology can improve the quality of autopsy reports and information available to families, clinicians, coroners and public health services 3,5–7 .…”

Section: Introductionmentioning

confidence: 99%

Histopathology at autopsy: why bother?

Matkowski

Benbow

2021

Histopathology

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Aims The frequency of histopathological sampling at autopsy varies, even though inadequate sampling may limit the value of autopsy reports. This study aims to investigate the contribution of histopathology at autopsy in a major teaching hospital. Methods and results A total of 532 coronial autopsy reports from Manchester Royal Infirmary were analysed retrospectively. Gross and microscopic diagnoses were compared and classified as concordant, discordant, histology needed (i.e. indeterminate or unremarkable gross findings) or autolysed. Revisions made to the cause of death following histopathology were categorised as: altered direct cause of death, altered indirect cause of death, concordant with supportive information, irrelevant or inconclusive. The study was limited to brain, heart, kidney, liver, lung and spleen. Histopathology had been requested in 141 cases (27%), which were further analysed. The greatest discordance between gross and microscopic findings was observed in the lung (11.6%). The organs most frequently requiring histopathology to provide a diagnosis were the kidney and lung, at 52.8 and 28.2%, respectively. Alterations were made to the direct cause of death in 45% of cases where histopathology was taken; it provided additional or supportive information in a further 38%. Diagnoses of primary malignancy had a sensitivity of 74% [confidence interval (CI) = 0.59–0.86] and bronchopneumonia had a sensitivity of 45% (CI = 0.29–0.62). Conclusion Histopathology has a major impact on the interpretation of organ pathology and determining a cause of death at autopsy.

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“…1 Previous studies have predominantly utilized autopsy data to determine discordance rates among pre-and post-mortem diagnoses and to identify pathologies at highest risk of misdiagnosis. Examples of such work that has provided valuable data to guide healthcare policy from around the world include pre-and post-mortem discordance rates of 9.3% in India, 2 12.3% in Canada, 3 17.2% in the USA, 4 18.1% in the Netherlands, 5 19.0% in Greece, 6 25.6% in Spain, 7 28% in Brazil, 8 and 48.4% in Jamaica. 9 Although this area of work has contributed considerably to the practice of diagnostic medicine, it is only beginning to scratch the surface of the potential applications of autopsy data.…”

mentioning

confidence: 99%