Consultation between forensic and clinical pathologists for histopathology examination after forensic autopsy

Abstract

The magnitude of the diagnostic benefit conferred by performing histopathological examinations after medico-legal/forensic autopsies remains debatable. We have tried to address this issue by reviewing a series of histopathology referrals concerning medico-legal autopsies in real-world routine practice. We present an audit of the consultations provided to forensics by clinical pathologists at our institute between 2015 and 2018. Over this period, 493 post-mortem examinations were performed by forensic pathologists. Of these cases, 52 (11%) were referred for histopathology. Gross assessment was requested in 22/52 (42%) cases. Histopathology examination was performed on single organs in 15/52 (29%) cases, primarily on the lung and heart, whereas parenchymatous multi-organ analysis was carried out in 14/52 (27%) cases. Bone-marrow sampling was studied in 4/52 (8%) cases. Immunohistochemistry was needed in 16/52 (31%) cases, special stains in 9/52 (21%) cases and molecular analysis in 4/52 (8%) cases. Focusing on technical processes, standard methodology on pre-analytical procedures was changed in 10/52 (19%) cases in order to answer specific diagnostic questions. We showed that although most of the time the diagnosis is clear by the end of dissection on the basis of the macroscopic findings, histopathology can provide, modify or confirm the cause of death in many medico-legal/forensic cases. Therefore, it is desirable that forensic pathologists and clinical pathologists establish robust working relationships in a cooperative environment. We conclude that it is important to implement guidelines based on real-world routine practice in order to identify cases where histopathology can provide useful contributions, which in our experience applied to 11% of forensic cases.

A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future

“…Hence, forensic experts and clinical pathologists must establish robust working relationships in a cooperative environment. And this fact is supported by a majority of researchers by their studies [6][7][8]34].…”

“…Communication between a forensic expert and a pathologist is an important step in making the postmortem diagnosis without misunderstanding [6][7][8]. A meticulous training is a must for all those who perform the clinical or medicolegal autopsy (MLA), and it is also necessary for a pathologist to get the verse in PE in the autopsy that includes grossing, microscopy, and interpretation since this is quite different from regular surgical pathology [9].…”

“…Lack of appropriate training of pathologists and forensic experts always widens the range of discrepancy of diagnosis. Geller et al along with many authors strongly recommended pathologists to improve the quality of PE[7][8][9]54,55]. Royal College Pathologist, European Society for Forensic Science, and American Academy of Forensic Sciences laid down various guidelines/protocols for death in different death scenarios with continuous training programs in the wake of updating and uniformity.…”

The Role of Histology in Forensic Investigations

“…This review, although not systematic and not exhaustive due to the massive volume of literature on the same, or closely-related, topic, shows that the relevance of this role is not limited to the human body, but involves many other fields of forensic investigations, with the ultimate aim of closing cases and ensure justice. While accepted as highly valuable, the access to histology by law enforcement and forensic practitioners is characterized by some meaningful challenges, such as the need of a dedicated wet laboratory, with inherent cost (Molina et al, 2007) and accreditation requirements (e.g., International Standard ISO 15189:2022), the specific expertise in the interpretation of samples, and the admissibility of the materials and the reports presented as court evidence (Cirielli et al, 2021). Therefore, securing an agreement with a public or private histology laboratory, usually associated to a hospital, is essential to ensure access to specialized expertise and equipment.…”

Forensic Pathology Education in Turkey: Insights From the National Forensic Pathology Awareness Survey

“…Despite its importance, histopathology at autopsy has faced criticism and challenges in recent years. Some have argued that the process is time-consuming and the results are often subjective, leading to a lack of standardization and accuracy in interpretation (2,3,8,9). Although post-mortem microscopic examination has decreased in some centers due to virtual autopsies performed in increasing numbers, it is still deemed necessary in the majority of autopsies in Türkiye (10).…”