Research Article - (2024) Volume 9, Issue 1
Background: Autopsies are done since the olden days to study anatomy, to learn pathology and to identify the cause of death. But this procedure is not widely accepted due to lack of facilities, reluctancies by relatives, various religious and ethical issues and fear of transmission of communicable diseases. Percutaneous needle autopsies have bridged these shortcomings and provide better results when done under radiological guidance.
Objectives: To determine the adequacy of tissue obtained by percutaneous needle autopsy in comparison to conventional autopsy for lung and liver tissues. Descriptive study, done in autopsies performed in the Department of Forensic Medicine and Department of Pathology, Government Medical College, Kottayam.
Methodology: Percutaneous needle samples are obtained from lungs and liver using surface landmarks. Samples are also obtained after opening the deceased body. After microscopic examination, adequacy is observed and morphological findings are compared.
Results: In lungs 164 samples met the adequacy criteria and 156 samples showed similar morphological findings by both methods; in liver 159 samples met the adequacy criteria and 151 samples showed similar morphological findings by both methods. In lungs and liver, most common histological finding was congestion.
Conclusions: Percutaneous needle autopsies and the tissue thus obtained are adequate and comparable when compared to conventional autopsies. The findings are more comparable in diffuse lesions rather than in localized lesions.
Adequacy • Conventional autopsy • Necropsy • Percutaneous needle autopsy • Histomorphology
Autopsies are of great value due to its importance in helping out to reach the cause of death in many suspicious and natural deaths [1,2]. Conventional autopsies are the mainstay and gold standard in this procedure, but they are not widely accepted due to many reasons.
Percutaneous needle autopsies help to overcome many of the hurdles which limit the use of conventional autopsies which made needle autopsies to be accepted in practice aided by radiological modalities which can improve the sample collection.
In our study, we chose lung and liver tissues for comparison primarily because of the ease in accessibility of these organs from outside the body.
A descriptive study was done on 188 autopsies. All autopsies done during the study period of 18 months in the adult population (above 18 years) were included except those cases where there was delay in post mortem procedure, cases with burns and decomposed bodies.
Using 11 size blade, a small nick is made over the sites proposed to take the biopsies. Using 16 G trucut biopsy needle, percutaneous samples are taken from lungs and liver using surface landmarks (liver–along the midclavicular line under the rib arch transabdominally, lung–both lungs at the level of 3rd intercostal space or from 6th to 7th intercostal space along the midaxillary line) [3]. Multiple passes (a minimum of 10 passes) are made. Sample is also taken when the deceased is opened for conventional autopsy (from suspicious areas also if any present). Samples obtained via both methods are fixed in 10% formalin, processed, stained using eosin and hematoxylin and examined and compared histopathologically. The adequacy is assessed by observing the following criteria:
Liver: Number of portal tracts (at least with 10 portal tracts and 1 cm in length) [4]. Cases which are inadequate but with significant pathological findings will be considered adequate.
Lungs: To obtain adequate samples, multiple passes are made covering wider area of lung tissue. Since there are no definite adequacy criteria for trucut biopsies in lungs, in our study, at least 10 passes will be made from each lung to obtain enough samples for histopathological examination and comparison. A minimum number of 75 alveoli in each core is considered as adequate in our study (a pilot study was done to obtain the adequate number of alveoli). Samples which have significant pathological findings will also be considered as adequate samples. The tissues obtained are observed and compared to study the proportion of the samples with similar morphological findings by both methods and adequacy is also observed. The data obtained are entered using Microsoft Excel, analyzed using SPSS software.
In our study, samples from both lungs and liver were obtained from all the 188 cases. In this study, maximum number of cases where from the age group 50-59 (26.6%) followed by 60-69 (22.3%) with 156 males (82.98%) and 32 females (17.02%). Considering the adequacy of trucut samples, 164 samples (87%) from lungs and 159 samples (85%) from liver were adequate. On comparing the histomorphological findings, 156 samples (83%) from lungs and 151 samples (80%) from liver showed similar and comparable morphological findings. Histomorphological categories were categorized as normal, non-significant pathology, significant pathology and lethal pathology. In our study, 153, 33 and 2 cases were categorized as non-significant, significant and lethal pathology respectively in lungs and 4,118 and 66 cases were categorized as normal, non-significant and significant pathology respectively in liver. The most common histomorphological finding in lungs and liver is congestion (Tables 1 and 2). The findings which were missed in trucut biopsies are pneumonia and emphysema in lungs and early cirrhotic changes in liver (Table 3). In our study, most of the deaths were due to road traffic accidents (34.6%) followed by hanging (23.9%) (Figure 1).
| Age group | CONG | Edema | HMG | Pigment | C/C INFL | EMPHY | PNEU |
|---|---|---|---|---|---|---|---|
| 20-29 | 15 | 10 | 3 | 8 | 1 | 1 | 2 |
| 30-39 | 13 | 10 | 0 | 5 | 0 | 2 | 4 |
| 40-49 | 24 | 18 | 0 | 6 | 1 | 1 | 4 |
| 50-59 | 37 | 27 | 4 | 12 | 1 | 3 | 7 |
| 60-69 | 27 | 28 | 4 | 12 | 3 | 2 | 5 |
| 70-79 | 13 | 12 | 0 | 6 | 0 | 0 | 2 |
| 80-89 | 8 | 5 | 1 | 5 | 1 | 3 | 0 |
| Note: CONG: Congestion; HMG: Hemorrhage; Pigment: Pigment laden macrophages; C/C INFL: Chronic Inflammation; EMPHY: Emphysema; PNEU: Pneumonia | |||||||
Table 1. Histomorphological findings in lungs age group wise.
| Age group | Normal | CONG | CHOLE | Fatty change | SIG STEA | SH | EC | CIR |
|---|---|---|---|---|---|---|---|---|
| 20-29 | 1 | 5 | 1 | 5 | 1 | 3 | 4 | 3 |
| 30-39 | 0 | 5 | 1 | 5 | 3 | 4 | 6 | 1 |
| 40-49 | 1 | 11 | 1 | 8 | 4 | 5 | 6 | 3 |
| 50-59 | 0 | 15 | 3 | 18 | 4 | 7 | 7 | 5 |
| 60-69 | 0 | 15 | 1 | 14 | 4 | 5 | 8 | 2 |
| 70-79 | 0 | 5 | 8 | 2 | 2 | 3 | 1 | 0 |
| 80-89 | 0 | 8 | 1 | 2 | 0 | 1 | 2 | 0 |
| Note: CONG: Congestion; CHOLE: Cholestasis; SIG STEA: Significant Steatosis; SH: Steatohepatitis; EC: Early Cirrhosis; CIR: Cirrhosis | ||||||||
Table 2. Histomorphological findings in liver age group wise.
|
Lung |
Liver |
|
|
Pneumonia |
Emphysema |
Early cirrhosis |
|
11 (6%) |
5 (3%) |
8 (4%) |
Table 3. Significant pathologies missed in trucut biopsies.
Figure 1. Image showing trucut biopsy procedure and comparison between trucut and conventional autopsy samples in cases with cirrhosis and pulmonary edema with emphysematous changes.
Needle autopsy has many advantages when considering routine autopsy like the procedure can be done by a trained personnel, samples can be collected from almost all organs using surface landmarks, the risk of disease transmission is less, autolytic features are minimal, procedure is less expensive, can be done immediately after death, samples can be submitted for frozen sections and electron microscopy, minimal or no disfigurement of the deceased. Documentations about needle autopsies are noted since 1955 (by Terry) [5-7]. In the earlier day’s necropsies/needle autopsies were done to detect HIV, cerebral malaria and circumstances where the consent for a complete autopsy were not obtained [8-10].
Even though the procedure is less cumbersome and feasible, its use is not widely accepted due to the inability to view the internal organs in situ, to obtain samples from small organs like parathyroid, adrenals, thymus, to obtain representative samples in cases with localized lesions in the organs [11].
Guided needle autopsies have bridged the gap which were seen in blind biopsies and are being used as a part of virtual autopsy and minimally invasive autopsy. Virtual autopsy can detect post mortem changes and identify the cause of death and is also feasible to collect samples from suspicious/localized lesions [12].
Guided autopsies can be done with the aid of ultra-sonogram or CT or MRI which can improve the success rates of obtaining representative samples.
The needle used for this purpose has undergone several modifications starting from Iversen Roholm needle and Vim Silverman needle to semiautomatic needles to automatic biopsy guns.
156 samples (83%) from lungs showed similar morphological findings in both trucut biopsy and conventional autopsies. In Foroudi, et al. study, 38% samples from lungs showed similar findings [13]. 151 samples (80%) from liver showed similar morphological findings in both trucut biopsy and conventional autopsies. In Foroudi, et al. study, 48 % of samples from liver showed similar findings. In Huston et al.’s study needle sampling correlated with the complete autopsy in 87% cases [14]. In West and Chomet’s study, 48% samples showed similarity (included samples from lung, liver and kidney) [15].
In our study, more than one histological finding was observed in majority of the cases for both lungs and liver. Non neoplastic findings were obtained in our study.
In lungs, the most common finding was congestion (137 cases, 72.87%) followed by edema (110 cases, 58.5%). Khare P, et al. study showed congestion and oedema to be the commonest finding in lungs [16]. In Thej Jagadish Mothakapalli, et al. study the majority of cases had congestion in 77.7% cases and oedema in 47.7% cases [17]. In Pathak A, et al. study, 57.7% cases showed congestion, 37.7 % cases showed edema and 24.4% showed pneumonia [18]. Terminal changes were seen which included pulmonary edema, emphysematous changes, congested blood vessels and presence of hemorrhage. The most common artefacts encountered were bubble artefacts, hemorrhage and artefactual collapse in trucut samples.
In liver, the most common finding was congestion, (34%) followed by fatty change (31.9%). Other findings are cholestasis (8%), significant steatosis (9.5%), steatohepatitis (11.1 %), early cirrhosis (18.08%). These findings were seen in combinations with each other and also with other findings and are comparable with other studies. In Ritu Bhagat, et al. study the most common finding was steatosis 32.5% [19]. According to Patel PR, et al. study venous congestion of liver is terminal end stage of the death seen in most of the liver autopsies [20]. In Singh et al.’s study, most of the cases on histopathological examination showed sinusoidal and vascular congestion (20 cases, 43.5%). In Jamila Alagarsamy, et al. study, majority of the cases had congestion 26%, followed by normal liver 22%, fatty changes 20%, cirrhosis 16%, hepatitis 10%.
Autolysis was observed in 2 (1%) cases in lungs and 14 (7%) cases in liver from trucut samples. Autolytic changes are minimal in trucut samples due to small size and better fixation of the samples.
Number of bronchioles could not be considered in adequacy criteria since they were not seen in most of the biopsy samples. In our study, only 48 cases showed bronchioles in the trucut samples.
We concluded that percutaneous needle autopsies and the tissue obtained are adequate and comparable when compared to conventional autopsies, the findings are more comparable in diffuse lesions rather than in localized lesions and findings from lungs are more comparable than from liver in needle autopsies.
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Citation: Roy M. "The Adequacy of Tissue Obtained by Percutaneous Needle Autopsy in Comparison to Conventional Autopsy for Lung and Liver Tissues". J Forensic Pathol, 2024, 9(1), 1-3.
Received: 17-Nov-2023, Manuscript No. JFP-23-28064; Editor assigned: 20-Nov-2023, Pre QC No. JFP-23-28064 (PQ); Reviewed: 04-Dec-2023, QC No. JFP-23-28064; Revised: 03-Jan-2024, Manuscript No. JFP-23-28064 (R); Published: 11-Jan-2024, DOI: 10.35248/2684-1312.24.09(1).001
Copyright: © 2024 Roy M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
