Utility of Autopsy in Uncovering Unexpected Neuropathology
RA Prayson. Cleveland Clinic Foundation, Cleveland, OH
Background: Autopsy rates have significantly declined in the last several decades for a variety reasons. One often cited reason is that with the improvement of various diagnostic modalities including imaging, diagnoses are more commonly and accurately made premortem, obviating the need for an autopsy. The purpose of this study is to compare neuropathologic (NP) findings from recent autopsies with findings from autopsies performed in the early 1980s to assess whether there is a decrease in the incidence of unexpected findings.
Design: Respective review of 328 autopsy brains from 1984-1985 (200 males, 61.0%; mean age 56.3 years) compared with 289 autopsy brains from 2007-2008 (160 males, 55.4%; mean age 57.6 years). The incidence of unexpected NP diagnoses, and in particular, unexpected diagnoses which were determined to be the major cause of death, were documented and compared.
Results: Unsuspected NP diagnoses were found at autopsy in 139 (42.4%) of cases from 1984-1985 versus 112 (38.8%) of cases from 2007-2008. The neuropathology was felt to significantly contribute to the cause of death in 72 patients (22.0%) in 1984-1985 versus 57 patients (19.7%) in 2007-2008. The most common cause of unexpected NP diagnoses in 1984-1985 included: acute/subacute infarct (14.8%), remote infarct (13.2%), hemorrhage (10.6%), metastatic cancer (4.2%) and vascular malformations (4.2%). The most common unexpected NP diagnoses in the 2007-2008 cohort included acute/subacute infarct (27.7%), Alzheimer's disease (22.3%), hemorrhage (18%), remote infarct (17.0%) and meningitis (9.8%). The incidence of unexpected NP diagnoses being the main cause of death was 5.2% in 1984-1985 versus 3.1% in 2007-2008.
Conclusions: Despite differences between styles of the autopsy report, pathologists, and types of cases autopsied, the findings would suggest that suspected NP findings are still found in over one-third of autopsy cases. Autopsy NP examination still plays a role in uncovering unexpected diagnoses which may be responsible for the main cause of death in a small but significant percentage of causes, underscoring the continued utility of brain and spinal cord examination at autopsy.
Tuesday, March 23, 2010 2:30 PM
Platform Session: Section G, Tuesday Afternoon