Autopsy diagnoses of malignant neoplasms: how often are clinical diagnoses incorrect?

CONTEXT Autopsy often reveals new diagnoses of malignant neoplasms, but as technological advances to improve diagnosis during life have improved, autopsy rates have declined dramatically. OBJECTIVE To determine if there is still a high discordance rate between clinical and autopsy diagnoses of malignant neoplasms despite increasing technological advances in diagnostic methods. DESIGN AND SETTING A 10-year retrospective study (1986-1995) of all autopsies performed at the Medical Center of Louisiana at New Orleans. PARTICIPANTS All patients autopsied, excluding preterm fetuses, at the Medical Center of Louisiana at New Orleans, by both Tulane and Louisiana State University Schools of Medicine in which consent was obtained or authorization given from the Orleans Parish Coroner's Office. MAIN OUTCOME MEASURES Discordance between clinical and autopsy diagnoses of malignant neoplasms. RESULTS A total of 1625 cases were reviewed of which 520 preterm fetuses were excluded. Of the remaining 1105 cases, 654 were male and 451 were female. The mean age was 48.3 years (range, 1-98 years). A total of 433 neoplasms were diagnosed, 250 of which were malignant. One hundred eleven malignant neoplasms in 100 patients had been either undiagnosed or misdiagnosed, and in 57 patients, the immediate cause of death could be attributed to the malignant neoplasm. The discordance between clinical and autopsy diagnoses of malignant neoplasms in this study is 44%, which is similar to previously reported studies. CONCLUSION The discordance rate between clinical and autopsy diagnoses of malignant neoplasms is large and confirms the importance of the postmortem examination.

[1]  M. Britton.  Clinical diagnostics: experience from 383 autopsied cases. , 2009, Acta medica Scandinavica.

[2]  C. Marwick.  Pathologists request autopsy revival. , 1995, JAMA.

[3]  A. Brollo,et al.  Diagnosis of malignant tumor: comparison between clinical and autopsy diagnoses. , 1995, Human pathology.

[4]  C K Redmond,et al.  Racial differences in survival from breast cancer. Results of the National Cancer Institute Black/White Cancer Survival Study. , 1994, JAMA.

[5]  M. Barbieri,et al.  Accuracy of clinical diagnoses in a teaching hospital: a review of 997 autopsies , 1993, Journal of internal medicine.

[6]  B. Radotra,et al.  Autopsy findings and clinical diagnoses: a review of 1,000 cases. , 1993, Human pathology.

[7]  V. Kanjuh,et al.  Correlation of clinical diagnoses with autopsy findings: a retrospective study of 2,145 consecutive autopsies. , 1986, Human pathology.

[8]  R. Manconi,et al.  Inaccuracy of death certificate diagnoses in malignancy: an analysis of 1,405 autopsied cases. , 1982, Human pathology.

[9]  H. M. Cameron,et al.  A prospective study of 1152 hospital autopsies: I. Inaccuracies in death certification , 1981, The Journal of pathology.

[10]  K. Suen,et al.  Cancer and old age. An autopsy study of 3,535 patients over 65 years old , 1974, Cancer.

[11]  S. Robbins,et al.  An autopsy study of cancer patients. I. Accuracy of the clinical diagnoses (1955 to 1965) Boston City Hospital. , 1972, JAMA.

[12]  H. G. Wells.  RELATION OF CLINICAL TO NECROPSY DIAGNOSIS IN CANCER AND VALUE OF EXISTING CANCER STATISTICS , 1923 .