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Re is a Cien í ica da O dem dos Médicos www.ac amedicapo uguesa.com
CARTAS AO EDITOR
Re isi ing Clinical Au opsies: Lessons o be Taken
om he COVID-19 Pandemic
Re isi ando a Au ópsia Clínica: Lições a Re i a da
Pandemia de COVID-19
Keywo ds: Au opsy; COVID-19
Pala as-cha e: Au opsia; COVID-19
Dea edi o ,
The numbe o clinical au opsies has been dec easing
signi ican ly in mos Eu opean coun ies, wi h g ea a iabil-
i y o au opsy a es, om 3% o 40%.1
Ne e heless, i is s ill pe o med as a ool o quali y
assessmen , as eaching me hod, as las esou ce o undi-
agnosed cases and o gain insigh in o disease pa hophysi-
ology.
The e a e a iable easons o he dec ease in au opsy
demand. The mos impo an one is pe haps he imp o e-
men o diagnos ic capaci y o complemen a y es s, bu
also he inc ease in he numbe o lawsui s agains physi-
cians and he ea o diagnos ic e o .
Pa hologis s also play a ole in his decline, since au-
opsy ac i i y is equen ly ega ded as a low p io i y and
commonly assigned o low expe ienced esiden s, mos ly
because o he o e load o wo k wi h inc easing complexi y.
Au opsy is a e y complex echnique, equi ing physi-
cal skills and in eg a ed heo e ical knowledge, since i is
no e o - ee, pa icula ly when pe o med by un ained pa-
hologis s. Some coun ies, as he Uni ed Kingdom, ha e
de ined clinical au opsy as a subspecial y o Pa hology,1 o
inc ease cele i y and con idence in his p ocedu e.
Disc epancies be ween clinical and au opsy indings
a e no in equen , wi h epo ed a es anging be ween
10% and 40%, usually classi ied unde Goldman c i e ia.2
In Cen o Hospi ala e Uni e si á io de Coimb a, a 11-yea
e iew, e ealed a disc epancy be ween an emo em and
pos mo em diagnoses o 38% in adul au opsies.3
The ede ini ion o au opsy me hods is impe a i e, wi h
some ecen p ocedu es epo ed, such as minimally in a-
si e au opsies, whe e adiological es s and guided biopsies
a e pe o med, wi h simila esul s o hose o con en ional
au opsy.4 This me hod equi es ha pa hologis s unde go
some basic aining in adiological s udies, bu may be
sa e , pa icula ly in cases o in ec ious diseases. I would
also minimize execu ion ime and p o ide as e answe s,
which is pa icula ly ele an gi en he gene alized lack o
pa hologis s.
The COVID-19 pandemic highligh ed he impo ance
o clinical au opsy, as a way o gaining knowledge abou
eme ging in ec ious agen s. The ypical indings in COV-
ID-19 a e espi a o y ac lesions, bu he e a e also less
common mani es a ions, such as li e inju y,5 so au opsy
may enligh en he pa hological spec um and p o ide in-
sigh s on ea men s.
Ca ying ou an au opsy is e en mo e challenging du -
ing he pandemic, since e y ew pa hology depa men s
ha e he p ope wo king condi ions. A easonable al e na-
i e would be he es ablishmen o p o ocols wi h o ensic
depa men s ha ha e hese acili ies.
In sho , a ede ini ion o au opsy me hods, he de elop-
men o p o ocols wi h o ensic depa men s and he c ea-
ion o a subspecialisa ion in clinical au opsy would be use-
ul in o de o imp o e his c ucial medical p ocedu e.
Rui ALMEIDA1,2, Rui Cae ano OLIVEIRA1,3,4
1. Pa hology Depa men . Cen o Hospi ala e Uni e si á io de Coimb a. Coimb a. Po ugal.
2. Facul y o Medicine. Uni e si y o Coimb a. Coimb a. Po ugal.
3. Biophysics Ins i u e. Facul y o Medicine. Uni e si y o Coimb a. Coimb a. Po ugal.
4. A ea o En i onmen Gene ics and Oncobiology. Coimb a Ins i u e o Clinical and Biomedical Resea ch. Facul y o Medicine. Uni e si y o Coimb a. Coimb a. Po ugal.
Au o co esponden e: Rui Almeida. [email p o ec ed]
Recebido: 02 de agos o de 2020 - Acei e: 03 de Agos o de 2020 | Copy igh © O dem dos Médicos 2020
h ps://doi.o g/10.20344/amp.14675
Ca as ao Edi o , Ac a Med Po 2020 Oc ;33(10):703-712
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