15283-B-Blokker

59 Alternatives to conventional autopsy: a systematic review 4 Agreement and accuracy of minimally invasive autopsy methods The oldest minimally invasive autopsy study applied a combination of tissue biopsies and post-mortem cultures, without any kind of imaging and showed an agreement and sensitivity of (almost) 60% for the cause of death. 107 They also showed a reasonably good agreement and sensitivity for new major findings. Two studies performing a combination of post-mortem laparoscopy, thoracoscopy and (if indicated) tissue biopsies showed very high agreement percentages for the cause of death. 112,113 However, one of these studies included very few cases (n=7) and the other selected cases to maximize the benefit of the studied method. There were two studies, by the same author, examining ultrasonography and (ultrasound-guided) biopsies in comparison to autopsy. 105,106 It is unknown if any of their cases were reported twice. The second study appeared to have worse outcomes than the first, but the agreement was still higher than in all non-invasive methods. Weustink et al. 57 evaluated a combination of MRI and CT, and ultrasonography-guided tissue biopsies, and showed agreement for cause of death in 76.7%. They were the only investigators who calculated specificity for overall findings, which was 99%. In their most recent study Wichmann et al. performed native CT and multiphase CT-angiography (no tissue biopsies). 80 With the addition of the CT-angiography the sensitivity of new major diagnoses had improved from 71.4% (MDCT only) to 92.9%. Two studies combined CT, CT-angiography and (CT-guided) tissue biopsies as alternative to conventional autopsy, 108,109 resulting in high sensitivities for cause of death: 94.7% and 89.5%. Both studies included twenty cases of which six appeared to be duplicates, so together they actually included 34 cases, of which 33 were eligible for this review, leading to a pooled sensitivity of 90.9% (95%CI: 74.5; 97.6). Further analyses or comparison between these studies was difficult, because of the heterogeneity in studied methods. Cost of alternative autopsy methods Although several studies mentioned costs, only one of them compared the actual cost of the two methods investigated. Weustink et al. 57 calculated a mean cost of $1497 ( 148 per minimally invasive autopsy, and $2274 ( 104 per conventional autopsy. Wichmann et al. 80 stated that the addition of angiography increased cost with $300 per case. Roberts et al. mentioned that alternative autopsies using MRI are more expensive than conventional autopsy. 102,110 Alternative autopsies using CT 59,102,103 or ultrasonography, 105,106 on the other hand, appear to be less expensive than conventional autopsy.