Feasibility of INTACT (INcisionless TArgeted Core Tissue) biopsy procedure for perinatal autopsy

Abstract

Objectives To determine the feasibility and tissue yield of a perinatal incisionless ultrasound‐guided biopsy procedure, the INcisionless Targeted Core Tissue (INTACT) technique, in the context of minimally invasive autopsy. Methods Cases of perinatal death in which the parents consented for minimally invasive autopsy underwent postmortem magnetic resonance imaging and an INTACT biopsy procedure, defined as needle biopsy of organs via the umbilical cord, performed under ultrasound guidance. In each case, three cores of tissue were obtained from seven target organs (both lungs, both kidneys, heart, spleen and liver). Biopsy success was predefined as an adequate volume of the intended target organ for pathological analysis, as judged by a pathologist blinded to the case and biopsy procedure. Results Thirty fetuses underwent organ sampling. Mean gestational age was 30 weeks (range, 18–40 weeks) and mean delivery‐to‐biopsy interval was 12 days (range, 6–22 days). The overall biopsy success rate was 153/201 (76.1%) samples, with the success rates in individual organs being highest for the heart and lungs (93% and 91%, respectively) and lowest for the spleen (11%). Excluding splenic samples, the biopsy success rate was 150/173 (86.7%). Histological abnormalities were found in 4/201 (2%) samples, all of which occurred in the lungs and kidneys of a fetus with pulmonary hypoplasia and multicystic kidney disease. Conclusions Incisionless ultrasound‐guided organ biopsy using the INTACT procedure is feasible, with an overall biopsy success rate of over 75%. This novel technique offers the ideal combination of an imaging‐led autopsy with organ sampling for parents who decline the conventional invasive approach. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses

“…Invasive examinations were performed in 29 of 236 fetuses (12.3%), which included a full conventional autopsy in 17 fetuses (58.6%), an MIA in 7 (24.1%) (this subset has also been reported in previous publications 20,21 ), and a limited autopsy in 5 (17.2%).…”

“…All autopsies were conducted in line with the standards set by the Royal College of Pathologists. 19 For cases in which consent was provided only for minimally invasive autopsy (MIA), these were conducted through either ultrasound-guided 20 or laparoscopic-guided biopsy techniques. 21 In our department, a death classification system is not used routinely, although a narrative exploration of findings linked to clinical history is provided in the final autopsy report.…”

“…Original Research OBSTETRICS ajog.org were conducted through either ultrasound-guided 20 or laparoscopic-guided biopsy techniques. 21 In our department, a death classification system is not used routinely, although a narrative exploration of findings linked to clinical history is provided in the final autopsy report.…”

Latest developments in post‐mortem foetal imaging

“…An alternative approach is to conduct image‐guided tissue biopsies. A recently pioneered method for avoiding any incisions is the INcision‐less Targeted Core Tissue (INTACT) biopsy method . Here, the biopsy needle is inserted into the abdominal cavity via the umbilical cord, where the needle can be then directed to various organs under the direction of ultrasound imaging, negating the need for a skin incision.…”

“…In cases where feticide has occurred, there may be both intracardiac gas and pneumothoraces, which could further obscure the transmission of sonographic waves. Nevertheless, when diagnostic, it could provide an alternative method for imaging where PMMR is not available or access is limited, and as above‐mentioned, it could aid in organ visualisation for targeted organ biopsies …”