Practice of percutaneous needle autopsy; a descriptive study reporting experiences from Uganda

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• 作者：Janneke A Cox (1) (2)
  Robert L Lukande (3)
  Sam Kalungi (3) (4)
  Koen Van de Vijver (5)
  Eric Van Marck (6)
  Ann M Nelson (7)
  Asafu Munema (3)
  Yukari C Manabe (2) (8)
  Robert Colebunders (1) (9)
  
  1. Department of Clinical Sciences ; Institute of Tropical Medicine ; Nationalestraat 155 ; 2000 ; Antwerpen ; Belgium
  2. Infectious Diseases Institute ; Makerere University College of Health Sciences ; Kampala ; Uganda
  3. Department of Pathology ; College of Health Sciences ; Makerere University ; Kampala ; Uganda
  4. Department of Pathology ; Mulago Hospital Complex ; Kampala ; Uganda
  5. Department of Diagnostic Oncology & Molecular Pathology ; Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital ; Amsterdam ; The Netherlands
  6. Department of Pathology ; University Hospital Antwerp ; University of Antwerp ; Antwerp ; Belgium
  7. Joint Pathology Center ; Silver Spring ; USA
  8. Division of Infectious Diseases ; Department of Medicine ; Johns Hopkins University School of Medicine ; Baltimore ; Maryland
  9. Faculty of Medicine ; University of Antwerp ; Antwerp ; Belgium
  
• 关键词：Needle autopsy ; Partial autopsy ; Minimal invasive autopsy ; Needle biopsy ; Ultra ; sound guided biopsy ; Tru ; cut biopsy ; Post mortem ; Uganda ; Sub Saharan Africa
• 刊名：BMC Clinical Pathology
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：335 KB
• 参考文献：1. Terry, R (1955) Needle necropsy. J Clin Pathol 8: pp. 38-41 CrossRef
  2. Wellmann, K (1969) The needle autopsy: a retrospective evaluation of 394 consecutive cases. Am J Clin Pathol 52: pp. 441-444
  3. Guerra, I, Ortiz, E, Portu, J, Atares, B, Aldamiz-Etxebarria, M, De Pablos, M (2001) Value of limited necropsy in HIV-positive patients. Pathol Res Pract 197: pp. 165-168 CrossRef
  4. Foroudi, F, Cheung, K, Duflou, J (1995) A comparison of the needle biopsy post mortem with the conventional autopsy. Pathology 27: pp. 79-82 CrossRef
  5. Baumgart, KW, Cook, M, Quin, J, Painter, D, Gatenby, PA, Garsia, RJ (1994) The limited (needle biopsy) autopsy and the acquired immunodeficiency syndrome. Pathology 26: pp. 141-143 CrossRef
  6. Huston, BM, Malouf, NN, Azar, HA (1996) Percutaneous needle autopsy sampling. Mod Pathol 9: pp. 1101-1107
  7. Flemming, JA, Hurlbut, DJ, Mussari, B, Hookey, LC (2009) Liver biopsies for chronic hepatitis C: should nonultrasound-guided biopsies be abandoned?. Can J Gastroenterol 23: pp. 425-430
  8. Maya, ID, Maddela, P, Barker, J, Allon, M (2007) Percutaneous renal biopsy: comparison of blind and real-time ultrasound-guided technique. Semin Dial 20: pp. 355-358 CrossRef
  9. Sperandeo, M, Rotondo, A, Guglielmi, G, Catalano, D, Feragalli, B, Trovato, GM (2014) Transthoracic ultrasound in the assessment of pleural and pulmonary diseases: use and limitations. Radiol Med 119: pp. 729-740 CrossRef
  10. Wong, EB, Omar, T, Setlhako, GJ, Osih, R, Feldman, C, Murdoch, DM, Martinson, NA, Bangsberg, DR, Venter, WD (2012) Causes of death on antiretroviral therapy: a post-mortem study from South Africa. PLoS One 7: pp. e47542 CrossRef
  11. Cox, JA, Lukande, RL, Kalungi, S, Van Marck, E, Van de Vijver, K, Kambugu, A, Nelson, AM, Manabe, YC, Colebunders, R (2014) Needle autopsy to establish the cause of death in HIV-infected hospitalized adults in Uganda: a comparison to complete autopsy. J Acquir Immune Defic Syndr 67: pp. 169-176 CrossRef
  12. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6890/14/44/prepub
  
• 刊物主题：Pathology; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1472-6890

文摘

Background Percutaneous needle autopsy can overcome a number of barriers that limit the use of complete autopsies. We performed blind-and ultrasound guided needle autopsies in HIV-infected adults in Uganda. In this study we describe in detail the methods we used, the ability of both procedures to obtain sufficient tissue for further examination and the learning curve of the operators over time. Methods If written informed consent was granted from the next of kin, we first performed a blind needle autopsy, puncturing brain, heart, lungs, liver, spleen and kidneys using predefined surface marking points. We then performed an ultrasound guided needle autopsy puncturing heart, liver, spleen and kidneys. The number of attempts, expected success and duration of the procedure were noted. A pathologist read the slides and indicated if the target tissue was present and of sufficient quality for pathological review. We report the predicted and true success rates, compare the yield of blind to ultrasound guided needle biopsies and evaluate the failure rate over time. Results Two operators performed 96 blind needle autopsies and 95 ultrasound guided needle autopsies. For blind needle biopsies true success rates varied from 56-99% and predicted success rates from 89-99%. For ultrasound guided needle biopsies true success rates varied from 72-100% and predicted success rates from 84-98%. Ultrasound guidance led to a significantly higher success rate in heart and left kidney. A learning curve was observed over time with decreasing failure rates with increasing experience and a shorter duration of the needle autopsy. Conclusion Needle autopsy can successfully obtain tissue for further pathological review in the vast majority of cases, with a decrease in failure rate with increasing experience of the operator. The benefit of ultrasound guidance will depend on the population, the disease and organ of interest and the local circumstances. Our results justify further evaluation of needle autopsies as a method to establish a cause of death.