Usefulness of Pathological Autopsy for Patients With Malignant Tumors

TL;DR

This study shows that pathological autopsies reveal significant differences between clinical diagnoses and actual findings in cancer patients, highlighting their value in understanding disease progression and causes of death.

Contribution

The study provides current evidence on the diagnostic discrepancies in malignant tumor patients using the Goldman criteria in a clinical setting.

Findings

32% of cases had major diagnostic discrepancies (Class I) that were not detectable by imaging.

44% of cases showed major discordance (Class I/II), including metastases to the gastrointestinal tract, biliary system, and pancreas.

Autopsies revealed conditions like sepsis, pulmonary infarction, and bone marrow carcinomatosis that were missed clinically.

Abstract

Introduction

Pathological autopsy is useful for elucidating pathological conditions and causes of death that are not known clinically. In recent years, pathological autopsies have decreased worldwide, and few studies have evaluated the discrepancy between clinical diagnosis and autopsy findings of malignant tumors. Goldman criteria classify discrepancies between clinical and pathological autopsy diagnoses, as follows: Class I (major discrepancies), missed major diagnosis; Class II (obvious discrepancies), missed major diagnosis; Class III, missed minor diagnosis; and Class IV, other missed minor diagnoses.

Objective

The Goldman criteria are used to assess discordance between antemortem clinical diagnosis and pathological autopsy, with major discordance rates reported at 16.6%-59%. The objective of this study was to investigate the usefulness of pathological autopsy in patients with malignant tumors.

Methodology

The Goldman criteria were applied to evaluate discordance between the antemortem clinical diagnosis and the diagnosis at pathological autopsy in 25 patients with malignant tumors who underwent pathological autopsy at the Department of Oncology, Fukuoka Wajiro Hospital, from December 2015 to May 2023, to assess the utility of pathological autopsy in clinical practice retrospectively.

Results

Eight patients (32%) were Class I, four (16%) were Class II in accordance with the Goldman criteria, and 11 (44%) were Class I/II, which was considered a major discordance. Class I discordance was difficult to diagnose by imaging and comprised histological discordance, sepsis, pulmonary infarction, disseminated intravascular coagulation, aplastic anemia, and bone marrow carcinomatosis. The most common conditions that were difficult to diagnose by imaging were metastases to the gastrointestinal tract, biliary system, and pancreas, which were more frequently revealed at pathological autopsy.

Conclusions

Pathological autopsy is a valuable tool for understanding the pathology of diseases as it reveals significant discrepancies between antemortem diagnoses and autopsy findings, particularly regarding disease extent, histological diagnosis, and causes of death.