Ultrasound-Guided Minimally Invasive Tissue Sampling: A Minimally Invasive Autopsy Strategy During the COVID-19 Pandemic in Brazil, 2020

Abstract

Background Minimally invasive autopsies, also known as minimally invasive tissue sampling (MITS), have proven to be an alternative to complete diagnostic autopsies (CDAs) in places or situations where this procedure cannot be performed. During the coronavirus disease 2019 (COVID-19) pandemic, CDAs were suspended by March 2020 in Brazil to reduce biohazard. To contribute to the understanding of COVID-19 pathology, we have conducted ultrasound (US)–guided MITS as a strategy. Methods This case series study includes 80 autopsies performed in patients with COVID-19 confirmed by laboratorial tests. Different organs were sampled using a standardized MITS protocol. Tissues were submitted to histopathological analysis as well as immunohistochemical and molecular analysis and electron microscopy in selected cases. Results US-guided MITS proved to be a safe and highly accurate procedure; none of the personnel were infected, and accuracy ranged from 69.1% for kidney, up to 90.1% for lungs, and reaching 98.7% and 97.5% for liver and heart, respectively. US-guided MITS provided a systemic view of the disease, describing the most common pathological findings and identifying viral and other infectious agents using ancillary techniques, and also allowed COVID-19 diagnosis confirmation in 5% of the cases that were negative in premortem and postmortem nasopharyngeal/oropharyngeal swab real-time reverse-transcription polymerase chain reaction. Conclusions Our data showed that US-guided MITS has the capacity similar to CDA not only to identify but also to characterize emergent diseases.

Spatially resolved single-cell atlas of the lung in fatal Covid19 in an African population reveals a distinct cellular signature and an interferon gamma dominated response

“…read haematoxylin and eosinstained tissue slides alongside patients' history and antemortem lab results, per standard clinical practice. In the lung in the Malawi Covid19 cohort the pathologist identified classical features of Covid19 described in other cohorts [20][21][22][23][24][25][26][27] , which were absent or less frequent in LRTD cases (Supplemental Data Fig. 1).…”

Hallazgos histopatológicos pulmonares en COVID-19. Experiencia de autopsias mínimamente invasivas

“…Diferentes estudios han reportado la progresión de la enfermedad desde DAD en fase exudativa hasta el desarrollo de fibrosis pulmonar. 10 El DAD se debe a la alteración ventilatoria que tienen estos pacientes. Las fases más comunes son la exudativa y la mixta.…”

“…13 La ecografía permite la visualización de la orientación de la toma de muestras, tiene bajo costo y buena portabilidad, lo que permite realizar MITS (muestreo de tejido mínimamente invasivo posmortem) también en el entorno hospitalario, fuera de la sala de autopsias. 10 Estudios realizados en Brasil señalan que la tasa de éxito en la recolección de muestras representativas es alta (70-100%) con una precisión de 81% a 90% según la región. 10…”

Could We Consider Ultrasound‐Guided Minimally Invasive Autopsy as a Part of POCUS?

“…8 Non-invasive autopsy ultrasound examination protocols are similar to those used in the evaluation of the abdomen, heart, and lung in point-of-care ultrasound. 9 In this article, we describe through three case reports, the initial experience of an AMI program developed by the Pathology Department together with the Internal Medicine Point Of Care ultrasound unit of an University Hospital.…”

“…Non‐invasive autopsy ultrasound examination protocols are similar to those used in the evaluation of the abdomen, heart, and lung in point‐of‐care ultrasound 9 …”