Post-mortem ultrasound-guided biopsies: A valuable tool for investigating novel diseases

While autopsies are the gold standard for investigating infectious diseases, their use is limited by infrastructure, staffing, or safety concerns during outbreaks. Post-mortem ultrasound-guided biopsies offer a practical, minimally invasive alternative for tissue sampling.

This case series included 60 deceased COVID-19 patients from Intensive Care Units (ICUs) and hospital wards (HWs). A total of 108 post-mortem specimens were obtained, including five necropsies, three of which were complemented by post-mortem biopsies. Percutaneous biopsies were performed at bedside within the first hour post-mortem, while necropsies were performed between 3h and 3 days after death. Samples were analysed using morphological, immunohistochemical (IHC), and ultrastructural techniques, including Transmission Electron Microscopy (TEM). Epidemiological and clinical data were collected prior to death.

Necropsies provided lung, heart, kidney, liver, spleen, bone marrow, and testicular samples, with procedure durations ranging from 3 to 5h. Tru-cut biopsies were faster, less invasive, and more cost-effective, with an average cost of €180 compared to €1500-€3000 for autopsies. High-quality samples for IHC and TEM analysis were obtained, with a success rate of 83% for lung biopsies, 100% for liver, 79% for kidney, and 67% for spleen samples. The minimally invasive nature of biopsies improved acceptance by families, particularly in cases when full autopsies were not feasible.

Post-mortem biopsies represent a valuable alternative to autopsies, providing high-quality samples, improved accessibility, lower costs, and faster processing. Their minimally invasive nature and ability to obtain key organ samples enhance feasibility in both clinical and research settings, supporting broader application in the investigation of emerging diseases.