Back

The Value of The Autopsy

Dr. Karen Cline, a first year Pathology Resident at the Virginia Commonwealth University Medical Center, presented The Autopsy, at the Pathology Club meeting, March 10.

"I'm here to talk about autopsies, which I do find very interesting," said Dr. Cline. "If you don't know why people die then you can't provide the proper facilities for living." Autopsies help the living by confirming immediate causes of death and by detecting underlying causes. Sometimes there are surprises.

Consider the case of the healthy man who suddenly collapsed and died while working on a clogged drain. A heart attack seems a likely cause, explained Dr. Cline, but the autopsy revealed he died from electrocution caused by faulty equipment. The family benefited from the discovery that this was a work-related injury and his fellow employees benefited from disposal of the faulty equipment. In another case, the CT scan of an elderly woman revealed multiple lesions on her brain. When she died just before exploratory surgery, an autopsy revealed the cause of the lesions to be periodontal disease.

But, most often, said Dr. Cline, there are no surprises and the diagnoses are confirmed. "In reality, most of the time a good autopsy dispels any notion that there has been any malpractice in the diagnosis and treatment of patients." What autopsies have provided is additional, detailed information. It's been shown in a recent study that the additional information provided by an autopsy may have changed the course of treatment about 27% of the time.

Detailed revelations gleaned from autopsies about the widely variable nature and progression of most diseases and conditions help doctors improve their diagnoses, prognoses and treatments. Autopsies also advance medical and scientific knowledge and are particular helpful in medical education. Pathology Residents study autopsy results in order to expand their knowledge and perfect their skills.

Autopsies help families too. "Overall, 88% of families report the autopsy was beneficial," Dr. Cline said. An autopsy can identify genetically linked diseases and can help the family procure insurance.

Despite their benefits, the number of autopsies has fallen. Prior to 1960, 70-80% of patients who died in the hospital were autopsied. In 1960, that number fell to about 40%, and currently stands at less than 10%. Autopsies are not covered by insurance. Either the hospital or the family has to pay the average $2000 for a full autopsy, or $750 for a brain autopsy. Additionally, major advances in diagnostic testing have improved diagnoses and prognoses significantly. Some believe the autopsy is an unnecessary expense.

"Advances in diagnostic technology have not decreased the value of an autopsy," she said. There are still some diseases, notably malignancies and infections, that are being missed, she said.

Forensic autopsies take place whenever a death is considered suspicious or non-natural. The autopsy procedure includes the external exam, followed by the opening of the trunk, the rib cage, and the pericardial sac. Then, organs are removed and prepared for study. If a funeral is delayed at all, it is usually by only a few hours. Additionally, after the body is closed, no sign is left to show that an autopsy has been performed and the body can still be embalmed.

Every Friday at 8am the VCUHS Department of Pathology convenes an autopsy conference to provide constructive critique of medical care. The first Tuesday of each month an autopsy follow-up conference is held.

Medical students at VCU Medical Center have a great opportunity to take advantage of opportunities to learn pathology by reviewing their patients' history with a pathologist or pathology resident; by shadowing a pathologist or pathology Resident; and by taking pathology electives or participating in pathology research. For more information and to shadow a pathologist or work in pathology research, please call the Department of Pathology at (804) 828-9746 and ask to speak with Dr. Sanford or email Dr. Sanford at ksanford@vcu.edu.

The Department of Pathology at VCUHS is composed of two major divisions: anatomic and clinical pathology. Anatomic pathology is made up of the cytopathology laboratory, the surgical pathology laboratory, and the autopsy room. Clinical pathology incorporates all other clinical testing laboratories--chemistry and toxicology, coagulation and hemostasis, microbiology and immunology, molecular diagnostics and the cytogenetics laboratories. It includes forensic pathology and transfusion medicine which houses the blood bank.

Pathologists' special training prepares them for many different roles and responsibilities in service to their patients and other medical professionals. One of those professionals is the laboratory technician. In surgical pathology at VCUHS, the day begins at the grossing station with biopsied tissue that is cut into cassettes. Inking is carefully applied to determine the surgical margins of lesions. A histotechnologist prepares histologic sections going through several detailed steps. Often, pathologists perform immunohistochemical staining to help determine a diagnosis. These special stains provide vital information about the diseased tissues.

Surgical pathologists also consult with surgeons. It's the pathologist's job to determine whether further surgery is needed. Because the patient is waiting, a quick decision is vital and usually made within 15 minutes. Surgical pathology collection materials and techniques include frozen sections, touch preps, gross examinations, and fine needle aspiration. When an organ needs evaluation before transplantation, it's the pathologist's job to evaluate and recommend the next step.

Clinical pathologist interpret challenging peripheral blood smears for diagnosis and recommended treatment in diseases and conditions like AIDS, hepatitis, leukemia, anemia, malaria, and lead poisoning. They perform and interpret bone marrow biopsies using new technologies in morphology, flow cytometry, clinical correlation, and molecular studies. They also evaluate patients with bleeding or clotting disorders, perform hemotherapy, including techniques in stem cell harvesting, plasmapheresis, leukopheresis, and red cell exchange. They coordinate blood transfusions, blood utilization and donation, and the identification of rare blood types. Most importantly, they oversee the care of trauma patients in need of massive transfusions.

Molecular pathologists are investigators of genetic structure and changes. They test for oncogenes in the diagnosis of cancer and for inherited genetic defects. They also provide DNA fingerprinting.

Research pathologists operate at the cutting edge of scientific inquiry into the cellular, molecular and genetic mechanisms behind aging, cancer, AIDs and other infectious diseases. At VCUHS we have pathology research programs in Aging & Cancer, Cellular & Molecular Pathogenesis, CTRF Cancer Genomics, Cytogenetics, Cytoproteomics, Functional Genomics, Molecular Diagnostics, Oncogenomics & Proteomics, and Paleopathology.