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European Radiology
Published in: European Radiology 4/2016

Open Access 01-04-2016 | Experimental

Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review

Authors: Britt M. Blokker, Ivo M. Wagensveld, Annick C. Weustink, J. Wolter Oosterhuis, M. G. Myriam Hunink

Published in: European Radiology | Issue 4/2016

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Abstract

Objectives

Autopsies are used for healthcare quality control and improving medical knowledge. Because autopsy rates are declining worldwide, various non-invasive or minimally invasive autopsy methods are now being developed. To investigate whether these might replace the invasive autopsies conventionally performed in naturally deceased adults, we systematically reviewed original prospective validation studies.

Materials and methods

We searched six databases. Two reviewers independently selected articles and extracted data. Methods and patient groups were too heterogeneous for meaningful meta-analysis of outcomes.

Results

Sixteen of 1538 articles met our inclusion criteria. Eight studies used a blinded comparison; ten included less than 30 appropriate cases. Thirteen studies used radiological imaging (seven dealt solely with non-invasive procedures), two thoracoscopy and laparoscopy, and one sampling without imaging. Combining CT and MR was the best non-invasive method (agreement for cause of death: 70 %, 95%CI: 62.6; 76.4), but minimally invasive methods surpassed non-invasive methods. The highest sensitivity for cause of death (90.9 %, 95%CI: 74.5; 97.6, suspected duplicates excluded) was achieved in recent studies combining CT, CT-angiography and biopsies.

Conclusion

Minimally invasive autopsies including biopsies performed best. To establish a feasible alternative to conventional autopsy and to increase consent to post-mortem investigations, further research in larger study groups is needed.

Key points

• Health care quality control benefits from clinical feedback provided by (alternative) autopsies.
• So far, sixteen studies investigated alternative autopsy methods for naturally deceased adults.
• Thirteen studies used radiological imaging modalities, eight tissue biopsies, and three CT-angiography.
• Combined CT, CT-angiography and biopsies were most sensitive diagnosing cause of death.
Appendix
Available only for authorised users
Literature
1.
Burton EC (2002) The autopsy: a professional responsibility in assuring quality of care. Am J Med Qual 17:56–60CrossRefPubMed
2.
Lundberg GD (1998) Low-tech autopsies in the era of high-tech medicine: continued value for quality assurance and patient safety. JAMA 280:1273–1274CrossRefPubMed
3.
Shojania KG, Burton EC, McDonald KM, Goldman L (2002) The autopsy as an outcome and performance measure. Evid Rep Technol Assess (Summ):1-5.
4.
Burton EC, Troxclair DA, Newman WP 3rd (1998) Autopsy diagnoses of malignant neoplasms: how often are clinical diagnoses incorrect? JAMA 280:1245–1248CrossRefPubMed
5.
Murken DR, Ding M, Branstetter BF, Nichols L (2012) Autopsy as a quality control measure for radiology, and vice versa. AJR Am J Roentgenol 199:394–401CrossRefPubMed
6.
Roulson J, Benbow EW, Hasleton PS (2005) Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathology 47:551–559CrossRefPubMed
7.
Scordi-Bello IA, Kalb TH, Lento PA (2010) Clinical setting and extent of premortem evaluation do not predict autopsy discrepancy rates. Mod Pathol 23:1225–1230CrossRefPubMed
8.
Shojania KG, Burton EC, McDonald KM, Goldman L (2003) Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA 289:2849–2856CrossRefPubMed
9.
Veress B, Alafuzoff I (1994) A retrospective analysis of clinical diagnoses and autopsy findings in 3,042 cases during two different time periods. Hum Pathol 25:140–145CrossRefPubMed
10.
Winters B, Custer J, Galvagno SM et al (2012) Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. Bmj Qual Saf 21:894–902CrossRefPubMed
11.
12.
Burton JL, Underwood J (2007) Clinical, educational, and epidemiological value of autopsy. Lancet 369:1471–1480CrossRefPubMed
13.
Gaensbacher S, Waldhoer T, Berzlanovich A (2012) The slow death of autopsies: A retrospective analysis of the autopsy prevalence rate in Austria from 1990 to 2009. Eur J Epidemiol 27:577–580CrossRefPubMed
14.
15.
Brown HG (1990) Perceptions of the autopsy: views from the lay public and program proposals. Hum Pathol 21:154–158CrossRefPubMed
16.
Burton JL, Underwood JC (2003) Necropsy practice after the "organ retention scandal": requests, performance, and tissue retention. J Clin Pathol 56:537–541CrossRefPubMedPubMedCentral
17.
Burton EC, Phillips RS, Covinsky KE et al (2004) The relation of autopsy rate to physicians' beliefs and recommendations regarding autopsy. Am J Med 117:255–261CrossRefPubMed
18.
19.
20.
21.
Hull MJ, Nazarian RM, Wheeler AE, Black-Schaffer WS, Mark EJ (2007) Resident physician opinions on autopsy importance and procurement. Hum Pathol 38:342–350CrossRefPubMed
22.
Loughrey MB, McCluggage WG, Toner PG (2000) The declining autopsy rate and clinicians' attitudes. Ulster Med J 69:83–89PubMedPubMedCentral
23.
Oluwasola OA, Fawole OI, Otegbayo AJ, Ogun GO, Adebamowo CA, Bamigboye AE (2009) The autopsy: knowledge, attitude, and perceptions of doctors and relatives of the deceased. Arch Pathol Lab Med 133:78–82PubMed
24.
Tsitsikas DA, Brothwell M, Chin Aleong JA, Lister AT (2011) The attitudes of relatives to autopsy: a misconception. J Clin Pathol 64:412–414CrossRefPubMed
25.
26.
27.
Brookes JAS, HallCraggs MA, Sams VR, Lees WR (1996) Non-invasive perinatal necropsy by magnetic resonance imaging. Lancet 348:1139–1141CrossRefPubMed
28.
Griffiths PD, Paley MNJ, Whitby EH (2005) Post-mortern MRI as an adjunct to fetal or neonatal autopsy. Lancet 365:1271–1273CrossRefPubMed
29.
Leth PM (2007) The Use of CT Scanning in Forensic Autopsy. Forensic Sci Med Pathol 3:65–69PubMed
30.
Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26:1305–1333CrossRefPubMed
31.
Ebert LC, Ptacek W, Naether S et al (2010) Virtobot--a multi-functional robotic system for 3D surface scanning and automatic post mortem biopsy. Int J Med Robot 6:18–27PubMed
32.
Thali MJ, Yen K, Schweitzer W et al (2003) Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)--a feasibility study. J Forensic Sci 48:386–403PubMed
33.
Le Blanc-Louvry I, Thureau S, Duval C et al (2013) Post-mortem computed tomography compared to forensic autopsy findings: a French experience. Eur Radiol 23:1829–1835CrossRefPubMed
34.
Ruder TD, Hatch GM, Ebert LC et al (2012) Whole Body Postmortem Magnetic Resonance Angiography. J Forensic Sci 57:778–782CrossRefPubMed
35.
36.
Liberati A, Altman DG, Tetzlaff J, et al. (2009) The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. Plos Medicine, 6. doi: 10.​1371/​journal.​pmed.​1000100
37.
Roberts ISD, Benamore RE, Benbow EW et al (2012) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: A validation study. Lancet 379:136–142CrossRefPubMedPubMedCentral
38.
Takahashi N, Higuchi T, Shiotani M et al (2012) The effectiveness of postmortem multidetector computed tomography in the detection of fatal findings related to cause of non-traumatic death in the emergency department. Eur Radiol 22:152–160CrossRefPubMed
39.
Westphal SE, Apitzsch J, Penzkofer T, Mahnken AH, Knuchel R (2012) Virtual CT autopsy in clinical pathology: Feasibility in clinical autopsies. Virchows Arch 461:211–219CrossRefPubMed
40.
Farina J, Millana C, Fdez-Acenero JM et al (2002) Ultrasonographic autopsy (echopsy): A new autopsy technique. Virchows Arch 440:635–639CrossRefPubMed
41.
Farina J, Millana C (1998) Applications of ultrasonography on the post-mortem examination (ecopsy) in humans. J Echogr Med Ultrasons 19:280–286
42.
Huston BM, Malouf NN, Azar HA (1996) Percutaneous needle autopsy sampling. MOD PATHOL 9:1101–1107PubMed
43.
Ross SG, Thali MJ, Bolliger S, Germerott T, Ruder TD, Flach PM (2012) Sudden death after chest pain: Feasibility of virtual autopsy with postmortem CT angiography and biopsy. Radiology 264:250–259CrossRefPubMed
44.
Bolliger SA, Filograna L, Spendlove D, Thali MJ, Dirnhofer S, Ross S (2010) Postmortem imaging-guided biopsy as an adjuvant to minimally invasive autopsy with CT and postmortem angiography: A feasibility study. Am J Roentgenol 195:1051–1056CrossRef
45.
Puranik RGB, Lackey H, Yeates L, Parker G, Duflou J, Semsarian C (2014) Comparison of conventional autopsy and magnetic resonance imaging in determining the cause of sudden death in the young. J Cardiovasc Magn Reson 16:44CrossRefPubMedPubMedCentral
46.
Wichmann D, Obbelode F, Vogel H et al (2012) Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit; A prospective cohort study. Ann Intern Med 156:123–130CrossRefPubMed
47.
Roberts ISD, Benbow EW, Bisset R et al (2003) Accuracy of magnetic resonance imaging in determining cause of sudden death in adults: Comparison with conventional autopsy. Histopathology 42:424–430CrossRefPubMed
48.
Patriquin L, Kassarjian A, O'Brien M, Andry C, Eustace S (2001) Postmortem whole-body magnetic resonance imaging as an adjunct to autopsy: Preliminary clinical experience. J Magn Reson Imaging 13:277–287CrossRefPubMed
49.
Wichmann D, Heinemann A, Weinberg C et al (2014) Virtual Autopsy With Multiphase Postmortem Computed Tomographic Angiography Versus Traditional Medical Autopsy to Investigate Unexpected Deaths of Hospitalized Patients. Ann Intern Med 160:534CrossRefPubMed
50.
Weustink AC, Hunink MGM, Van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW (2009) Minimally invasive autopsy: An alternative to conventional autopsy? Radiology 250:897–904CrossRefPubMed
51.
Fan JKM, Tong DKH, Poon JTC et al (2010) Multimodality minimally invasive autopsy-A feasible and accurate approach to post-mortem examination. Forensic Sci Int 195:93–98CrossRefPubMed
52.
Cacchione RN, Sayad P, Pecoraro AM, Ferzli GS (2001) Laparoscopic autopsies. Surg Endosc 15:619–622CrossRefPubMed
53.
Thayyil S, Chandrasekaran M, Chitty LS et al (2010) Diagnostic accuracy of post-mortem magnetic resonance imaging in fetuses, children and adults: a systematic review. Eur J Radiol 75:e142–e148CrossRefPubMed
54.
Bolliger SA, Thali MJ, Ross S, Buck U, Naether S, Vock P (2008) Virtual autopsy using imaging: bridging radiologic and forensic sciences. A review of the Virtopsy and similar projects. Eur Radiol 18:273–282CrossRefPubMed
55.
Flach PM, Thali MJ, Germerott T (2014) Times have changed! Forensic radiology--a new challenge for radiology and forensic pathology. AJR Am J Roentgenol 202:W325–W334CrossRefPubMed
56.
Avrahami R, Watemberg S, Daniels-Philips E, Kahana T, Hiss J (1995) Endoscopic autopsy. Am J Forensic Med Pathol 16:147–150CrossRefPubMed
57.
Saunders SL, Morgan B, Raj V, Rutty GN (2011) Post-mortem computed tomography angiography: Past, present and future. Forensic Sci Med Pathol 7:271–277CrossRefPubMed
58.
Roberts ISD, Benamore RE, Peebles C, Roobottomd C, Traill ZC (2011) Diagnosis of coronary artery disease using minimally invasive autopsy: evaluation of a novel method of post-mortem coronary CT angiography. Clin Radiol 66:645–650CrossRefPubMed
59.
Saunders SL, Morgan B, Raj V, Robinson CE, Rutty GN (2011) Targeted post-mortem computed tomography cardiac angiography: proof of concept. Int J Legal Med 125:609–616CrossRefPubMed
60.
Germerott T, Preiss US, Ebert LC et al (2010) A new approach in virtopsy: Postmortem ventilation in multislice computed tomography. Leg Med (Tokyo) 12:276–279CrossRef
61.
Robinson C, Biggs MJ, Amoroso J, Pakkal M, Morgan B, Rutty GN (2014) Post-mortem computed tomography ventilation; simulating breath holding. Int J Legal Med 128:139–146CrossRefPubMed
62.
Rutty GN, Biggs MJP, Brough A et al (2015) Ventilated post-mortem computed tomography through the use of a definitive airway. Int J Legal Med 129:325–334CrossRefPubMed
63.
Christe A, Ross S, Oesterhelweg L et al (2009) Abdominal Trauma-Sensitivity and Specificity of Postmortem Noncontrast Imaging Findings Compared With Autopsy Findings. J Trauma-Inj Infect Crit Care 66:1302–1307CrossRef
64.
Burton JL, Rutty GN The Hospital Autopsy: A Manual of Fundamental Autopsy Practice (Hodder Arnold Publication). CRC Press; 3 edition (25 Jun 2010).
65.
66.
Jackowski C, Schweitzer W, Thali M et al (2005) Virtopsy: Postmortem imaging of the human heart in situ using MSCT and MRI. Forensic Sci Int 149:11–23CrossRefPubMed
67.
Bruguier C, Mosimann PJ, Vaucher P et al (2013) Multi-phase postmortem CT angiography: recognizing technique-related artefacts and pitfalls. Int J Legal Med 127:639–652CrossRefPubMed
68.
Fryer EP, Traill ZC, Benamore RE, Roberts IS (2013) High risk medicolegal autopsies: is a full postmortem examination necessary? J Clin Pathol 66:1–7CrossRefPubMed
69.
70.
Ebert LC, Ptacek W, Furst M, Ross S, Thali MJ, Hatch G (2012) Minimally invasive postmortem telebiopsy. J Forensic Sci 57:528–530CrossRefPubMed
71.
Lundstrom C, Persson A, Ross S et al (2012) State-of-the-art of visualization in post-mortem imaging. Apmis 120:316–326CrossRefPubMed
Metadata
Title
Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review
Authors
Britt M. Blokker
Ivo M. Wagensveld
Annick C. Weustink
J. Wolter Oosterhuis
M. G. Myriam Hunink
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 4/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-015-3908-8

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