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Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and
J C Hutchinson1,2, S C Shelmerdine2,3, C Lewis4,5
1Department of Histopathology, Great Ormond Street Hospital for Children, London, UK.
Objective:
Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death.
Methods:
This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5-year period. Following preprocedure 1.5-T whole-body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi-square analysis was used to compare the 'unexplained' rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy.
Results:
MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy.
Conclusions:
The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high- and low/middle-income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
Insights
The Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) procedure provides adequate tissue samples for diagnosing fetal, neonatal, and pediatric deaths. This technique offers a viable alternative when full autopsy consent is limited.
Area of Science:
- Forensic Pathology
- Pediatric Pathology
- Medical Imaging
Background:
- Less invasive autopsy methods are preferred by parents but often yield inadequate tissue samples.
- Needle biopsy studies show poor sampling adequacy in fetal and infant death investigations.
- Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) aims to improve diagnostic yield through better tissue collection.
Purpose of the Study:
- To evaluate the experience and effectiveness of the MinImAL procedure in cases of fetal, neonatal, and pediatric death.
- To assess the diagnostic yield and feasibility of MinImAL compared to standard autopsy methods.
Main Methods:
- Retrospective analysis of 103 cases undergoing MinImAL over 5 years.
- Preceded by 1.5-T whole-body postmortem MRI.
- Assessed procedure duration, sampling adequacy, and cause of death; compared unexplained intrauterine death rates with standard autopsy.
Main Results:
- MinImAL was successful in 97.8% of cases.
- Satisfactory histological sampling was achieved in most major organs (e.g., heart, lung, kidney at 100%).
- Procedure duration was comparable to standard autopsy; unexplained stillbirth rates were similar.
Conclusions:
- MinImAL provides good histological yield with minimal cosmetic damage, suitable for training.
- It is an appropriate minimally invasive alternative for perinatal and pediatric deaths when full autopsy is declined.
- The MinImAL procedure has potential applications in diverse healthcare settings.
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