Histopathology at autopsy: why bother?

Abstract

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.

The utility of histology in assessing the cause of death in medico‐legal autopsies in selected trauma deaths: Suspension‐, immersion‐, fire‐, and traffic‐related

“…Two earlier studies have found large effects of histology [6,7], whereas others have not [8][9][10]. The two studies with large effects [6,7] and one of the studies with a small effect [8] used unselected medico-legal populations. However, the paper with a small effect had a population where natural causes of death constituted only 23% of cases.…”

“…Histology is undoubtedly useful in natural deaths [4,5], but studies in a medico-legal setting have shown inconsistent results [6][7][8][9][10][11][12].…”

“…Histology is undoubtedly useful in natural deaths [4, 5], but studies in a medico‐legal setting have shown inconsistent results [6–12]. In a prospective study of 428 decedents subjected to a medico‐legal autopsy, histology changed the assessment of the “mechanism of death” in 40% of cases and the assessment of the cause of death in 8% of cases [6].…”

Medico-legal analysis of cases of children who died suddenly due to pneumonia undiagnosed in their lifetime

“…This was reflected in the analysis, where the average number of lung sections in the study group was 5.4, and in the control group -6.3. Taking too few specimens or improperly preserving them (e.g., placing too large specimens in too small a volume of formalin) can result in failure to diagnose disease (including, but not limited to, pneumonia) in post-mortem examinations [28].…”

“…umieszczenie zbyt dużych wycinków w zbyt małej objętości formaliny) może skutkować nierozpoznaniem choroby (w tym m.in. zapalenia płuc) w badaniach post mortem [28].…”