The evolution of minimally invasive tissue sampling in postmortem examination: a narrative review

Abstract

Background: Because of low acceptance rates and limited capacity, complete diagnostic autopsies (CDAs) are seldom conducted in low-and middle-income countries (LMICs). There have been growing investments in less-invasive postmortem examination methodologies, including needle-based autopsy, known as minimally invasive autopsy or minimally invasive tissue sampling (MITS). MITS has been shown to be a feasible and informative alternative to CDA for cause of death investigation and mortality surveillance purposes. Objective: The aim of this narrative review is to describe historical use and evolution of needlebased postmortem procedures as a tool to ascertain the cause of death, especially in LMICs. Methods: Key word searches were conducted in PubMed and EBSCO in 2018 and 2019. Abstracts were reviewed against inclusion and exclusion criteria. Full publications were reviewed for those abstracts meeting inclusion criteria and a start set was established. A snowball search methodology was used and references for all publications meeting inclusion criteria were manually reviewed until saturation was reached. Results: A total of 1,177 publications were initially screened. Following an iterative review of references, 79 publications were included in this review. Twenty-nine studies, published between 1955 and 2019, included MITS as part of postmortem examination. Of the publications included, 76% (60/79) have publication dates after 2010. More than 60% of all publications included addressed MITS in LMICs, and a total of nine publications compared MITS with CDA. Conclusions: Although there is evidence of less-invasive postmortem sampling starting in the 1800s, more structured needle-based postmortem examination publications started to appear in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 the number of publications began to increase, and a growing number of studies were conducted in LMICs. Initial studies in LMICs were disease-specific but since 2015 have evolved to include more expansive postmortem examination.

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

“…Minimally invasive autopsy (MIA), also known as minimally invasive tissue sampling [ 13 , 14 ], is a needle-based approach aimed at collecting samples of the main organs and fluids without opening the body. MIA has been validated as an alternative to conventional autopsy [ 15 , 16 , 17 , 18 ].…”

Validating a Minimally Invasive Tissue Sampling (MITS) Method in Determining Cause of Death in Stillbirths and Neonates

“…Congenital malformations, deformities and chromosomal abnormalities were the second cause of death in our patients’ cohort, representing 20.8% of all the cases. In a previous study in stillbirths and neonates in Mozambique, intrauterine hypoxia ranked third in cause of death diagnosis, preceded only by fetal growth restrictions and infectious diseases [ 8 ]. A South African study found that congenital malformations were the leading cause of death (22.1%) in children 1–59 months of age [ 19 ].…”

“…In developing countries, the World Health Organization’s (WHO) approved criteria for verbal autopsies have been used as an alternative to determine cause of death, but these have shown significant levels of imprecision and a high degree of misclassification errors [ 7 , 8 ]. In Kazakhstan, the observed decline in autopsy rates is no exception, particularly as regards death occurring in adults (unpublished report).…”

Why Should Clinical Autopsies Continue to Exist?

“…With the advent of "personalized medicine", especially in treating patients with cancer, pathology assumed a crucial role in determining cancer therapies with specific molecular guidance for mutated genes. An excellent option increasingly used is the minimally invasive autopsy (MIA) guided by imaging examinations [22]. MIA would play a preponderant role in clinical research with the targeted retrieval of tumor fragments from metastases or recurrences after aggressive treatments such as chemotherapy or radiotherapy.…”