Revisiting Clinical Autopsies: Lessons to be Taken from the COVID-19 Pandemic

708 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 ALMEIDA1,2, 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 REFERENCES 1. Al sen G, Pon inha C. Au opsies in Eu ope. Resul s o a su ey among he membe s o he Eu opean Socie y o Pa hology (ESP). Vi chows A ch. 2018;473:120. 2. an den Tweel J, Wi ekind C. The medical au opsy as quali y assu ance ool in clinical medicine: d eams and eali ies. Vi chows A ch. 2016;468:75–81. 3. Lai A, Pimen ão M, Ramalhosa F, Fa ia C, Almeida V, Mo ei a H, e al. Adul clinical nec opsies: he gold s anda d o clinical p ac ice a e dec easing wo ldwide. And in Coimb a? A e ospec i e s udy om 2007 o 2018 compa ing clinical and au opsy diagnoses. Vi chows A ch. 2019;475:34. 4. Blokke B, Weus ink A, Wagens eld I, Von de Thüsen J, Pezza o A, Damme s R, e al. Con en ional au opsy e sus minimally in asi e au opsy wi h pos mo em MRI, CT, and CT-guided biopsy: compa ison o diagnos ic pe o mance. Radiology. 2018;289:658–67. 5. Lee I, Huo T, Huang Y. Gas oin es inal and li e mani es a ions in pa ien s wi h COVID-19. J Chin Med Assoc. 2020;83:521–3.