Hutchinson, C;
Shelmerdine, SC;
Lewis, C;
Parmenter, J;
Simcock, IC;
Ward, L;
Ashworth, MT;
... Sebire, NJ; + view all
(2019)
Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure.
Ultrasound in Obstetrics & Gynecology
, 54
(5)
pp. 661-669.
10.1002/uog.20211.
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Abstract
OBJECTIVES: Less invasive autopsy techniques have good acceptability to parents, but the published sampling adequacy of needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopic assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst concomitantly permitting visualisation, extraction and examination of internal organs through a small incision. We present the findings of the MinImAL procedure in a cohort of 103 unselected perinatal and paediatric cases performed at a tertiary referral centre over five years. METHODS: Following a pre-procedure 1.5 T whole-body post-mortem MRI, MinImAL autopsy was performed. Data was collected prospectively and analysed retrospectively. Chi-square analysis was used to compare the 'unexplained' rate of intrauterine deaths within the cohort with a previously published cohort of intrauterine deaths. RESULTS: MinImAL autopsy was performed successfully in 97.8% (91/93) of cases. We found satisfactory rates of adequate histological sampling in most major organs; heart (100%, 91/91 cases), lung (100%, 91/91 cases), kidney (100%, 91/91 cases), liver (96.7%, 88/91 cases), spleen (94.5%, 86/91 cases), adrenal glands (89%, 81/91 cases), pancreas (82.4%, 75/91 cases) and thymus (56%, 51/91 cases). Procedure duration was similar to standard autopsy. There was no statistically significant increase in the 'unexplained' rate for stillbirths that received MinImAL autopsy when compared with a previously published cohort of >1,000 cases. CONCLUSIONS: MinImAL provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. MinImAL is an appropriate minimally invasive alternative for the investigation of perinatal and paediatric deaths where consent to full autopsy is withheld, and may have applications in both high and low-middle income settings. This article is protected by copyright. All rights reserved.
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