In-Vivo and Post-Mortem Gallstones: Support for Validity of the “Epidemiologic Necropsy” Screening Technique

Abstract

This research was done to evaluate the "epidemiologic necropsy" procedure as a "screening" technique for disease that has been clinically unsuspected or inactive during life. The post-mortem occurrence rates of gallstones in necropsies at Yale-New Haven Hospital were compared and found reasonably similar to the analogous rates of gallstones detected in-vivo via ultrasonographic screening of large general populations. Because the authors could not find an appropriate in-vivo screening study done in the United States, they used data mainly from screening studies in Copenhagen, Denmark, and Rome and Sirmione, Italy. Two additional ultrasonographic screening studies have been done in Norway and in populations of Hispanic Americans. Previous disparities between post-mortem and in-vivo screening results probably arose because of failure to stratify for age and sex, to remove patients with cholecystectomy from the analysis, or to account for small-size stones that would be detected at necropsy but not with ultrasonography. The current results help confirm the value of the epidemiologic necropsy procedure in estimating the size of the substantial reservoir of undetected disease that does not appear in the customary tabulations of "vital statistics."

Gallstone disease prevalence in Western Siberia: Cross‐sectional ultrasound study versus autopsy

“…Therefore, our data are in full agreement with previous studies that found no significant difference in the prevalence of gallstones in a general population and their frequency from the autopsy analysis 13–15 . Such a comparison of ultrasound and autopsy data simultaneously in the same area was performed in Denmark by Jorgensen et al 15 However, the authors, having received similar results, supposed that this finding might be coincidental due to an inappropriate detection of gallstones during routine autopsy.…”

“…The level of operative activity and skill of surgical and anesthesiological personnel may influence the intra‐ and postoperative mortality. That is why Simonovis et al recommended excluding cholecystectomized subjects from epidemiological analysis concerning gallstone prevalence 13 …”

“…In the last decade, three studies 13–15 have shown that gallstone prevalence rates estimated by two different methods: ultrasonography and autopsy, are reasonably similar. This is of scientific interest because it allows us to compare present ultrasonographic survey data in different ethnic groups with previous autopsy studies.…”

Accuracy of clinical diagnoses in a teaching hospital: a review of 997 autopsies

“…Autopsy information has established many new diseases and their mechanisms, diagnostic errors, therapeutic errors, and, in many instances, has led to the development of new therapeutic methods [l]. The autopsy is indispensable in epidemiological work, not only for estimating the considerable reservoir of undetected disease, but for relatively simple conditions such as gallstones [ 2 ] , or for serious diseases such as malignancy [3]. The advances in diagnostic techniques have not reduced the value of autopsy, which remains a vital component to ensure good medical care [4].…”

Non-Surgical Approaches to Stones in the Biliary Tree

“…Simonovis et al [ 1 ] from Yale have recently shown that direct comparison of gall stone prevalence is difficult to assess due to the vari ation in diagnostic facilities and attitudes to treatment modalities, but more importantly because many patients are symptom free. Cholesterol gall stones account for about 80% of all gall bladder calculi in Europe.…”