Lung India : official organ of Indian Chest Society · 2026
Diagnostic performance of minimally invasive autopsy in a respiratory ICU: A retrospective analysis.
СтатьяНазвание и аннотация: Перевод в очереди
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Saxena Puneet, Bal Amanjit, Singh Pawan K, Dhooria Sahajal, Prasad Kuruswamy T, Muthu Valliappan, Gupta Nalini, Aggarwal Ashutosh N, Agarwal Ritesh, Sehgal Inderpaul S
Аннотация
BACKGROUND: Post-mortem tissue sampling can help determine the cause of death, particularly in resource-limited settings. We conducted a retrospective audit of minimally invasive autopsies (MIA) performed in a respiratory intensive care unit.
METHODS: Lung biopsies were obtained using either a core biopsy needle (CBN) or through a small thoracic incision at the fourth intercostal space (open incision method [OIM]). We performed a kidney or liver biopsy using a CBN with ultrasound guidance. The final cause of death, ascertained by a multidisciplinary team, served as the reference standard. The primary objective was to assess biopsy yield and the frequency of diagnostic revision based on histopathological findings.
RESULTS: One hundred and sixteen patients underwent MIA. Lung biopsies were done in all cases (66 [56.9%] by CBN and 50 [43.1%] by OIM). Kidney and liver were biopsied in less than 10% of cases. Twelve biopsies (10.3%) were non-representative and excluded from further analysis. The overall biopsy yield was 74%. Pathological findings led to a change in the final diagnosis in three cases (2.9%). Infections aetiologies were most common, including bacterial pneumonia (24, [23.1%]), fungal pneumonia (8, [7.7%]), and tuberculosis (2, [1.9%]). Malignancy was identified in 8 (7.7%) cases. The diagnostic yield was significantly higher with OIM than with CBN (87.5% vs. 62.5%, P = 0.004). Agreement between clinical and pathological diagnoses was fair (kappa = 0.41, P < 0.001).
CONCLUSION: MIA achieved a 74% diagnostic yield with fair agreement with the MDT-determined cause of death. OIM provided a superior yield compared to CBN and may be preferable where feasible.
METHODS: Lung biopsies were obtained using either a core biopsy needle (CBN) or through a small thoracic incision at the fourth intercostal space (open incision method [OIM]). We performed a kidney or liver biopsy using a CBN with ultrasound guidance. The final cause of death, ascertained by a multidisciplinary team, served as the reference standard. The primary objective was to assess biopsy yield and the frequency of diagnostic revision based on histopathological findings.
RESULTS: One hundred and sixteen patients underwent MIA. Lung biopsies were done in all cases (66 [56.9%] by CBN and 50 [43.1%] by OIM). Kidney and liver were biopsied in less than 10% of cases. Twelve biopsies (10.3%) were non-representative and excluded from further analysis. The overall biopsy yield was 74%. Pathological findings led to a change in the final diagnosis in three cases (2.9%). Infections aetiologies were most common, including bacterial pneumonia (24, [23.1%]), fungal pneumonia (8, [7.7%]), and tuberculosis (2, [1.9%]). Malignancy was identified in 8 (7.7%) cases. The diagnostic yield was significantly higher with OIM than with CBN (87.5% vs. 62.5%, P = 0.004). Agreement between clinical and pathological diagnoses was fair (kappa = 0.41, P < 0.001).
CONCLUSION: MIA achieved a 74% diagnostic yield with fair agreement with the MDT-determined cause of death. OIM provided a superior yield compared to CBN and may be preferable where feasible.