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Comparative Study
. 2019 Jun 5;152(1):36-49.
doi: 10.1093/ajcp/aqz016.

Comparison of Minimally Invasive Tissue Sampling With Conventional Autopsy to Detect Pulmonary Pathology Among Respiratory Deaths in a Resource-Limited Setting

Drucilla J Roberts  1 , Henry N Njuguna  2 , Barry Fields  3 , Corinne L Fligner  4 , Sherif R Zaki  5 , M Kelly Keating  5 , Emily Rogena  6 , Edwin Walong  6 , Andrew K Gachii  7 , Elizabeth Maleche-Obimbo  6 , Grace Irimu  6 , John Mathaiya  6 , Noelle Orata  6 , Rosemarie Lopokoiyit  6 , Jackson Michuki  6 , Gideon O Emukule  2 , Clayton O Onyango  2 , Stella Gikunju  8 , Collins Owuor  8 , Peter K Muturi  9 , Milka Bunei  9 , Marc-Alain Widdowson  2   3 , Joshua A Mott  10 , Sandra S Chaves  2   10
Affiliations
Comparative Study

Comparison of Minimally Invasive Tissue Sampling With Conventional Autopsy to Detect Pulmonary Pathology Among Respiratory Deaths in a Resource-Limited Setting

Drucilla J Roberts et al. Am J Clin Pathol. .

Abstract

Objectives: We compared minimally invasive tissue sampling (MITS) with conventional autopsy (CA) in detection of respiratory pathology/pathogens among Kenyan children younger than 5 years who were hospitalized with respiratory disease and died during hospitalization.

Methods: Pulmonary MITS guided by anatomic landmarks was followed by CA. Lung tissues were triaged for histology and molecular testing using TaqMan Array Cards (TACs). MITS and CA results were compared for adequacy and concordance.

Results: Adequate pulmonary tissue was obtained by MITS from 54 (84%) of 64 respiratory deaths. Comparing MITS to CA, full histologic diagnostic concordance was present in 23 (36%) cases and partial concordance in 19 (30%), an overall 66% concordance rate. Pathogen detection using TACs had full concordance in 27 (42%) and partial concordance in 24 (38%) cases investigated, an overall 80% concordance rate.

Conclusions: MITS is a viable alternative to CA in respiratory deaths in resource-limited settings, especially if combined with ancillary tests to optimize diagnostic accuracy.

Keywords: Conventional autopsy; Minimally invasive tissue sampling technique; Pediatric mortality; Postmortem investigation; Pulmonary pathology; Resource limited; Respiratory illness death; TaqMan Array Card.

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Figures

Figure 1
Figure 1
Diagram illustrating the sites for lung tissue specimen collection using minimally invasive tissue sampling techniques, sample handling and transport, and test and laboratory location. CDC, Centers for Disease Control and Prevention; IDPB, Infectious Diseases Pathology Branch; KEMRI, Kenya Medical Research Institute.
Figure 2
Figure 2
Distribution of pathogens detected using TaqMan Array Card in tissues collected through conventional autopsy (CA) and minimally invasive tissue sampling techniques (MITS) in children younger than 5 years hospitalized with respiratory illness in Kenya from 2014 to 2015.
Figure 3
Figure 3
Distribution of viral and bacterial pathogens detected using TaqMan Array Card (TAC) weighted by number of autopsies done over the 5 days from death to postmortem examination. CA, conventional autopsy; MITS, minimally invasive tissue sampling.
See this image and copyright information in PMC

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