15283-B-Blokker

55 Alternatives to conventional autopsy: a systematic review 4 INTRODUCTION Current problem and background Autopsy is an age-old method for identifying the underlying pathology leading to death, and/ or for detecting unnatural deaths. It is an important tool for both criminal investigations and for healthcare quality control. In clinical practice, autopsy contributes to medical knowledge, medical training, accurate mortality statistics, epidemiologic databases, and therapeutic and diagnostic improvements. 17-19 Despite continuing development of innovative new diagnostic techniques, there are substantial discrepancies between ante-mortem and post-mortem diagnoses. 8-10,13,14,86,90,91 Hence, autopsy continues to provide medical professionals with valuable feedback on provided care and possibly new insights for future decision- making. In some cases it also leads to counselling advice for family members. Clinical autopsy rates are rapidly decliningworldwide. 22,23,32 Toperformclinical autopsies, consent from next-of-kin is obligatory in most countries. Unfortunately, consent may not be requested or recommended by physicians (who are often junior staff members) and is often refused by bereaved families. 30,38,39,41,81-85,87,92 Public resistance to autopsies has increased over the years, due to negative press attention, 24 funeral delay, religious or cultural beliefs, and fear of mutilation of the deceased’s body. For the latter reason, non-invasive or minimally invasive autopsy methods, which were already implemented in forensic medicine, are currently being developed to substitute clinical invasive autopsies. 22,24,32 Over the last decades, MR imaging has been introduced in clinical medicine for perinatal and neonatal autopsy. 93,94 Many other clinically established imaging techniques have emerged for broad post-mortem use in forensic medicine. Among these are image- guided tissue biopsies, and CT- or MR- angiography. 48,95-99 Forensic specialists have optimized them for post-mortem settings. However, despite high diagnostic performance in that field, hardly any of the new post-mortem techniques have been implemented in clinical medicine. Purpose In this systematic review we investigate whether non-invasive or minimally invasive autopsy methods could replace conventional autopsy in adults with a suspected natural cause of death. We calculate the sensitivity and agreement of non-invasive and minimally invasive autopsy methods using conventional autopsy as reference standard, and discuss if any method may be appropriate for a clinical setting.