Pulmonary tumor embolism: A retrospective study over a 30-year period

Abstract

Background Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis. Methods We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival. Results We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240). Conclusions The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.

A Picture Is Worth 2,000 Words

“…The most common primary tumors to present with PTE are breast, gastric, hepatocellular, urothelial, esophageal, lung, and pancreatic carcinomas. 4 Unfortunately, PTE is rarely diagnosed ante mortem, and its prevalence in autopsy series of patients with solid tumors ranges between 3% and 26% and is dependent on the institution’s autopsy sampling rate. 3 , 4 Discrepancy between the antemortem clinical diagnosis and the postmortem autopsy diagnosis has not improved substantially over the past 30 years.…”

“… 3 , 4 Discrepancy between the antemortem clinical diagnosis and the postmortem autopsy diagnosis has not improved substantially over the past 30 years. 4 …”

Nontrombotic Pulmonary Embolism: Different Etiology, Same Significant Consequences

“…A very recent study intended to determine the discrepancies between the antemortem diagnosis and autopsy results. The conclusion was that despite a significant improvement in radiological technologies over the past 30 years, the disparity between antemortem diagnosis and autopsy does not differ significantly [ 95 ].…”

Pulmonary Tumor Embolism Complicated by Metastatic Liver Carcinoma in Female With Primary Breast Carcinoma

“…It was identified that all the patients had advanced carcinoma with distant metastases, and metastatic liver carcinoma was observed in 14 patients. It was also reported that breast carcinoma was among the most common primary malignancy overall [ 5 ]. This case study includes an elderly female patient with breast carcinoma with secondary metastasis to the liver and pulmonary embolus tumor.…”