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Accelerating Proficiency in Minimally Invasive Autopsy for Infectious Disease Diagnosis and Research: A Strategic
Fabiana Santana Souza1, Carlos Gustavo Regis-Silva1, Ricardo Khouri1
1Fundação Oswaldo Cruz, Instituto Gonçalo Moniz, Salvador, BA, Brazil.
Background:
Conventional autopsy is the gold standard for postmortem examination, but its use is constrained by biosafety, infrastructure, and acceptability concerns. Ultrasound-guided minimally invasive autopsy and ultrasound-guided minimally invasive tissue sampling (US-MITS) offer practical alternatives for tissue sampling in infectious diseases. The aim of this study was to present a standardized protocol for multiorgan US-MITS and evaluate its performance in terms of success rates, accuracy, and sample quality.
Methods:
An observational study was conducted on 13 decedents with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed coronavirus disease 2019 in Salvador, Brazil. Using a portable ultrasound machine and 14G semi-automatic Tru-Cut needles, samples were collected from the skin, liver, spleen, kidneys, pancreas, lungs (four-quadrant bilateral sampling), heart, brain, and skeletal muscle. The workflow included routine histological examinations (hematoxylin and eosin, and special stains), electron microscopy, and molecular testing via Ion Torrent sequencing for severe acute respiratory syndrome coronavirus 2 variant calling. Performance was evaluated by measuring the success rates and accuracy (ratio of target tissue to contaminants) using high-resolution slide scanning and digital morphometry.
Results:
Sampling success ranged from 77% to 100% across the heart, lungs, liver, spleen, and kidneys. Four-quadrant lung sampling yielded comprehensive histological representation. Contamination was generally low, except in the pancreas and lower medial lung quadrant. Tissue suitable for electron microscopy was obtained from most organs; severe acute respiratory syndrome coronavirus 2 was detected in all 13 lungs, and variants were assigned in 10 cases.
Conclusion:
With minimal training, teams can perform US-MITS. Using a traceable, standardized workflow accelerates proficiency while enabling diagnostic-grade samples to be produced for histological examinations, ultrastructural analysis, and molecular testing in resource-limited and outbreak settings.
