A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future

Pathological examination (PE) encompasses a gross or macroscopy and histopathological or microscopic examination. It is prudent in finding the cause of death (COD) in clinical and medicolegal autopsies. There are various auxiliary techniques in the form of clinical history, communication, specialized training, and protocols for consolidation of the PE results. After a thorough search of the literature in PubMed with relevant keywords along with further analysis of the results, it emerged that even with the modernization of forensic medicine, a PE is unbeatable in detecting the COD. It has various useful aspects, apart from regular finding the COD, such as in student teaching, epidemiology of disease, audit tool, and quality assurance. There are also limitations of PE, which should be dealt with great caution. Hence, limitations must be understood by a forensic expert as well as a pathologist. In this review, all factors that are related to PE in any manner are discussed in detail, and the scope for improving the quality of PE to be relevant in the present scenario is reviewed. It is a comprehensive reassessment of the literature review that also casts light on the future along with a critical analysis of the facts that deal with PE.

[1]  E. Baccino,et al.  [Forensic autopsies and pathological examination: Current practice in Montpellier's jurisdiction. A retrospective study of 630 autopsies]. , 2021, Annales de pathologie.

[2]  Jayanthi Yadav,et al.  COVID-19 Autopsy in India: Protocols, Procedures, and Experiences , 2021, Cureus.

[3]  B. Lhermitte,et al.  [Histopathological diagnosis of an intoxication]. , 2021, Annales de pathologie.

[4]  H. Herbst,et al.  Discrepancies between clinical diagnosis and hospital autopsy: A comparative retrospective analysis of 1,112 cases , 2021, PloS one.

[5]  V. Melinte,et al.  Incidence of thyroid carcinomas in an extended retrospective study of 526 autopsies , 2021, Experimental and therapeutic medicine.

[6]  C. Portwine,et al.  Diagnostic discrepancies between antemortem clinical diagnosis and autopsy findings in pediatric cancer patients , 2021, Virchows Archiv.

[7]  M. Brunelli,et al.  Consultation between forensic and clinical pathologists for histopathology examination after forensic autopsy , 2021, Medicine, science, and the law.

[8]  C. Venkataswamy,et al.  Pathologist's role in identifying cardiac defects- a foetal autopsy series. , 2020, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[9]  C. Basso,et al.  Autopsy examination in sudden cardiac death: a current perspective on behalf of the Association for European Cardiovascular Pathology , 2020, Virchows Archiv.

[10]  H. S. Kim,et al.  Proposal of the Autopsy Guideline for Infectious Diseases: Preparation for the Post-COVID-19 Era (abridged translation) , 2020, Journal of Korean medical science.

[11]  P. Hofman,et al.  Pulmonary pathology and COVID-19: lessons from autopsy. The experience of European Pulmonary Pathologists , 2020, Virchows Archiv.

[12]  D. Lanjewar,et al.  Analysis of Causes of Death as Determined at Autopsy in a Single Institute, The Grant Medical College and Sir J. J. Hospital, Mumbai, India, Between 1884 and 1966: A Retrospective Analysis of 13 024 Autopsies in Adults. , 2020, Archives of pathology & laboratory medicine.

[13]  Changhong Yang,et al.  The pathologic autopsy of coronavirus disease 2019 (COVID-2019) in China: a review , 2020, Pathogens and disease.

[14]  Herkutanto,et al.  A review of the diversity in taxonomy, definitions, scope, and roles in forensic medicine: implications for evidence-based practice , 2018, Forensic Science, Medicine and Pathology.

[15]  P. Glasziou,et al.  Prevalence of incidental breast cancer and precursor lesions in autopsy studies: a systematic review and meta-analysis , 2017, BMC Cancer.

[16]  S. Cordner,et al.  Autopsy histopathology where the prosector is not a histopathologist: a proposal , 2017, Forensic Science, Medicine and Pathology.

[17]  P. Khare,et al.  Prevalence of Lung Lesions at Autopsy: A Histopathological Study. , 2017, Journal of clinical and diagnostic research : JCDR.

[18]  Sapna Patel,et al.  Histopathologic Findings in Autopsies with Emphasis on Interesting and Incidental Findings-A Pathologist's Perspective. , 2016, Journal of clinical and diagnostic research : JCDR.

[19]  N. Sebire,et al.  Stillbirth and intrauterine fetal death: role of routine histological organ sampling to determine cause of death , 2016, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[20]  D. Höflmayer,et al.  Description of in-hospital deaths in Vienna during 1850–2000 , 2016, Wiener Medizinische Wochenschrift.

[21]  K. Girisha,et al.  What does fetal autopsy unmask in oligohydramnios? , 2015, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[22]  J. G. van den Tweel,et al.  The medical autopsy as quality assurance tool in clinical medicine: dreams and realities , 2015, Virchows Archiv.

[23]  M. Osborn,et al.  Hospital autopsy: Endangered or extinct? , 2015, Journal of Clinical Pathology.

[24]  M. Sajin,et al.  Clinical or postmortem? The importance of the autopsy; a retrospective study. , 2014, Maedica.

[25]  E. Behr,et al.  The importance of specialist cardiac histopathological examination in the investigation of young sudden cardiac deaths. , 2014, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[26]  R. Dettmeyer The role of histopathology in forensic practice: an overview , 2014, Forensic Science, Medicine, and Pathology.

[27]  I. Scheimberg The genetic autopsy , 2013, Current opinion in pediatrics.

[28]  H. Sevestre,et al.  Intérêt de l’analyse anatomopathologique dans une série de 400 autopsies médicolégales , 2012 .

[29]  N. Sebire,et al.  Histological examination in sudden unexpected death in infancy: evidence base for histological sampling , 2011, Journal of Clinical Pathology.

[30]  K. Nakajima,et al.  Pokkuri Death Syndrome; sudden cardiac death cases without coronary atherosclerosis in South Asian young males. , 2011, Forensic Science International.

[31]  M. Sheppard,et al.  Guidelines for autopsy investigation of sudden cardiac death , 2007, Virchows Archiv.

[32]  P. Charlier,et al.  Usefulness of Systematic Histological Examination in Routine Forensic Autopsy * , 2010, Journal of forensic sciences.

[33]  H. Dienes,et al.  [Autopsy records in Cologne from 1914 to 1960: changes in diseases, society and institution]. , 2008, Der Pathologe.

[34]  Julian L Burton,et al.  Clinical, educational, and epidemiological value of autopsy , 2007, The Lancet.

[35]  N. Halpern,et al.  Premortem clinical diagnoses and postmortem autopsy findings: discrepancies in critically ill cancer patients , 2007, Critical care.

[36]  D. Molina,et al.  Is Routine Histopathologic Examination Beneficial in All Medicolegal Autopsies? , 2007, The American journal of forensic medicine and pathology.

[37]  P. Hasleton,et al.  Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta‐analysis and review , 2005, Histopathology.

[38]  R. Kotabagi,et al.  Clinical Autopsy vs Medicolegal Autopsy. , 2005, Medical journal, Armed Forces India.

[39]  M. Fishbein,et al.  Forensic autopsy in a pathology training program. , 1998, Archives of pathology & laboratory medicine.

[40]  K. Nadesan The importance of the medico-legal autopsy. , 1997, The Malaysian journal of pathology.

[41]  A. Takatsu [Sudden unexpected natural death from a viewpoint of forensic pathology]. , 1995, Nihon hoigaku zasshi = The Japanese journal of legal medicine.

[42]  P. Silcocks,et al.  Attitudes of senior pathologists towards the autopsy , 1994, The Journal of pathology.

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

[44]  P. Berry Pathological findings in SIDS. , 1992, Journal of clinical pathology.

[45]  C. B. Tripathi,et al.  Medicolegal autopsies in India. Delay and nonperformance--adverse effects. , 1984, The American journal of forensic medicine and pathology.

[46]  J. Carter,et al.  Misdiagnosis of bronchogenic carcinoma. The role of cigarette smoking, surveillance bias, and other factors , 1980, Cancer.

[47]  B. Hansen Heart Autopsy in Ischemic Heart Disease , 1978, Acta pathologica et microbiologica Scandinavica. Section A, Pathology.

[48]  A. Becker,et al.  Fat distribution in the adrenal cortex as an indication of the mode of intrauterine death. , 1976, Human pathology.

[49]  E. M. Butt,et al.  Diseases and deaths; a statistical survey of 40,130 autopsies at the Los Angeles County General Hospital, 1918 to 1948. II. , 1953, California medicine.

[50]  H. Emerson,et al.  Errors in Clinical Statements of Causes of Death-Second Report. , 1943, American journal of public health and the nation's health.

[51]  Indian Medical Service , 1883, Edinburgh medical journal.

[52]  C. Delteil,et al.  Pediatric medicolegal autopsy in France: A forensic histopathological approach. , 2018, Journal of forensic and legal medicine.

[53]  R. Matěj,et al.  [The autopsy of the brain and spinal cord in the diagnosis of neurodegenerative diseases - a practical approach to optimize the examination]. , 2015, Ceskoslovenska patologie.

[54]  S. Geller,et al.  Gross examination. , 2014, Methods in molecular biology.

[55]  D. Höflmayer,et al.  [Autopsy records in Vienna since Lorenz Biermayer--a complete documentation of 195 years]. , 2013, Wiener medizinische Wochenschrift.

[56]  B. Aleksandrić,et al.  Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users. , 2011, Vojnosanitetski pregled.

[57]  N. Sangle,et al.  Histological spectrum of liver in HIV - autopsy study. , 2005, Annals of hepatology.

[58]  A. Zaitoun,et al.  The value of histological examination in the audit of hospital autopsies: A quantitative approach , 1998, Pathology.

[59]  P. Kutumbiah Ancient Indian Medicine , 1959 .