Undiagnosed Fatal Malignant Tumor in Adult Autopsies: A 10 Year Retrospective Study
Shobha Parajuli, Amandeep Aneja, Nahum J Duker, Mark P Birkenbach, Abir L Mukherjee. Temple University Hospital, Philadelphia, PA
Background: Autopsy rates have declined worldwide. There is a perception that modern diagnostic imaging /laboratory techniques have made autopsy less useful. Numerous studies have shown utility of autopsy for uncovering previously undiagnosed major findings, including cancer. However, most of these studies also include incidental cancers. Few recent publications have focussed on clinically unsuspected malignancy as the primary cause of death in the setting of a university hospital.
Design: A retrospective analysis of consecutive adult hospital autopsies from January 2002 to December 2011 was done. The study includes autopsies performed on patient's ≥ 18 years of age in which primary cause of death is malignancy which was not diagnosed prior to autopsy. The detailed autopsy report, clinical record including duration of hospital stay, radiological imaging reports and relevant laboratory results were reviewed from laboratory and hospital database.
Results: 821 adult autopsies were performed over a period of 10 years. Sixty nine clinically undiagnosed malignant neoplasms were found in sixty six (8%) cases. In twenty six out of these sixty six cases the undiagnosed malignant neoplasm was the primary cause of death (3.1%). The duration of hospital stay was <24 hours in eight (30.7%), 2-7 days in nine (34.6%) and >7 days in nine (34.6%) cases respectively. In ten out of twenty six cases (1.2%) there was suspicion of malignancy without definitive tissue diagnosis based on clinical history, radiological studies or laboratory tests (average hospital stay 4.9 days). In sixteen out of twenty six cases (1.9%), malignancy was not clinically suspected (average hospital stay 9.9 days). The clinically undiagnosed fatal malignant neoplasms were dominated by lung tumors (4 squamous cell carcinomas, 2 adenocarcinomas and 2 small cell carcinomas). Other malignancies in this group included ductal carcinoma of breast, ovarian serous carcinoma, adenocarcinomas of colon and gallbladder, poorly differentiated sarcoma (in a background of polycystic liver disease) and three cases of diffuse large B cell lymphoma.
Conclusions: In spite of recent advances in diagnostic imaging and laboratory techniques, a subset of adult autopsies (3.1%) done in a university hospital showed clinically undiagnosed fatal malignancy and in 1.9% of these cases malignancy was not suspected despite significant hospital stay. Hospital autopsy continues to be an important auditing tool for diagnostic accuracy in the first decade of twenty first century.
Wednesday, March 6, 2013 9:30 AM
Poster Session V # 2, Wednesday Morning