The Needle Autopsy: A Retrospective Evaluation of 394 Consecutive Cases

Wellmann, Klaus F.

doi:10.1093/ajcp/52.4.441

Cited by 21 publications

(19 citation statements)

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“…The results presented are comparable with those described previously for adults, with adequate samples obtained from the liver in 92% of cases, the heart in 55%, the lung in 46% and the kidney in 34% [17]. A more recent-but smaller-study reported successful biopsy of the adult lung in 100% of 21 cases to only 9.5% for the kidney [7].…”

Section: Discussionsupporting

confidence: 87%

Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy

et al. 2007

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To determine the feasibility of percutaneous fetal organ biopsies in the context of a 'minimally invasive' perinatal autopsy after stillbirth and termination for abnormality is the aim of this study. We assessed successful biopsy rate and the proportion adequate for histological examination in 30 fetuses undergoing organ sampling before autopsy. The relationship between gestational age, body weight, death-biopsy interval, operator experience and successful biopsy rate was investigated. Significant findings from conventional block histology were compared with corresponding percutaneous biopsies. Of 210 organ biopsies attempted from seven target organs, 107 were obtained, of which 94 were adequate for pathological comment. The median delivery-autopsy interval was 4 (range 2-11) days. Adequate samples were obtained from the lung in 86% cases (95% CI 68, 96%), liver 76% (95% CI 56, 90%) and less frequently for the myocardium, kidney, adrenal, thymus and spleen. There was no relationship between biopsy success and time to biopsy, gestational age, body weight and user experience. No histological abnormalities found at autopsy were diagnosed from needle biopsies. Although targeted percutaneous biopsies appear feasible for some organs, fewer than 50% of all biopsies are adequate for histological examination. This technique cannot be considered to provide useful clinical information as part of a 'minimally invasive' perinatal autopsy.

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Section: Discussionsupporting

confidence: 87%

Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy

et al. 2007

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“…Reports on needle autopsy have shown a 67%, 48% and 43% sensitivity rate for the diagnosis of the cause of death compared with conventional autopsy [3,5,12]. In 1969, Wellman [11] reported the results of 394 needle autop- diagnostic accuracy in these systems. We have had trouble obtaining a good acoustic window that allows ventricular thickness to be measured reliably, especially as measurements while the patient is alive are made at the peak of the QRS complex, which is obviously lacking after death.…”

Section: Discussionmentioning

confidence: 99%

“…This author was only able to confirm 54% of the tumours diagnosed while the patient was alive using the samples obtained, and the diagnostic reliability was therefore low. Although these figures have remained unchanged in more recent reports [11], interest in this technique has recently been renewed by the appearance of new infectious diseases that pose too high a risk for the pathologist performing the autopsy. Some authors have advocated the use of needle autopsy to confirm the clinical diagnosis in this type of patient [1,4,10].…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic autopsy (echopsy): a new autopsy technique

Fariña¹,

Millana²,

Fdez-Aceñero³

et al. 2002

Virchows Arch

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Autopsy has been one of the most important techniques for the development of modern medicine, mainly during the nineteenth century and the first half of last century. However, in the last few years, the number of autopsies performed in hospitals has dramatically decreased all over the world. This loss of interest can be attributed both to important advances in other diagnostic and therapeutic techniques and to the fear of malpractice suits. Several groups have tried to overcome this problem, developing different autopsy techniques, one of which is needle autopsy. Most authors using this technique have acknowledged that it is difficult to obtain material from certain organs and lesions, which makes its diagnostic reliability worse than that of conventional autopsy. To overcome this drawback, our team has recently developed a modification of needle autopsy, called ultrasonographic autopsy or echopsy, in which samples are obtained under ultrasonographic control. We report the results of the first 100 cases of echopsy performed in our hospital, comparing this technique with conventional autopsy performed on all the corpses. The concordance rate for the cause of death and the main pathological diagnosis between echopsy and classical autopsy was 83% in our series, which makes echopsy a feasible and reliable alternative to conventional autopsy in cases in which families refuse to give their consent for classical autopsy or in cases of infectious diseases.

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“…The technique of postmortem needle biopsy is not new [6] . The technique offers two major advantages over the conventional approach: it is less time-consuming and is performed at bedside before decomposition occurs, thereby, making it possible to apply a wide range of investigational methods that include microbiological and immunological studies, frozen sections, and electron microscopy [7] .…”

Section: Discussionmentioning

confidence: 99%

“…Among the cases diagnosed, bronchiolitis obliterans organizing pneumonia ( fi g. 1 ), disseminated meningococcal meningitis, adult Rye syndrome, unsuspected paracetamol intoxication, thrombotic thrombocytopenic purpura, fulminant infl uenza A viral infection, cytomegalovirus infection ( fi g. 2 ) and vasculitis were not considered common fi ndings in our area. Compared to the study by Wellman [6] , in this study, adequate tissue was sampled for determining 'meaningful pathological alterations' because we made three basic adjustments: trained staff performed the 'tissue harvesting'; pieces of the lung (and intestine) were sampled, and guided biopsies were made based on prior knowledge of history, physical examination, laboratory investigations and radiological fi ndings. Acceptance of the 'limited postmortem sampling' technique by nextof-kin was higher (83%) than conventional autopsy (13%) [3] primarily due to the 'non-deforming' nature of needle biopsy.…”

Section: Discussionmentioning

confidence: 99%

Postmortem Biopsies: The Experience in Kuwait

El-Reshaid¹,

El-Reshaid²,

Madda³

2005

Med Princ Pract

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Objective: To report our 4-year experience in postmortem needle biopsy of liver, heart, kidney and lung tissues when formal autopsy could not be performed. Subjects and Methods: In the period from January 2000 to December 2003, postmortem biopsies were done at Al-Amiri Hospital, Kuwait, in 19 cases where the original diagnosis or cause of death was not clear. The procedure was performed by a dedicated trained medical team using a biopsy needle or limited incisions guided by the knowledge of the clinical presentation and results of laboratory and radiological investigations. Results: The actual diagnosis was established in 8 cases by postmortem histological findings and corrected in another 9 cases. In the remaining 2 cases with systemic sepsis, autopsy only confirmed the antemortem clinical diagnosis. Conclusion: Our study shows that needle biopsy is an adequate technique for postmortem examination and should be considered as the minimum alternative to conventional autopsy.

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The Needle Autopsy: A Retrospective Evaluation of 394 Consecutive Cases

Cited by 21 publications

References 0 publications

Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy

Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy

Ultrasonographic autopsy (echopsy): a new autopsy technique

Postmortem Biopsies: The Experience in Kuwait

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