Original Article

Virchows Archiv

, Volume 452, Issue 2, pp 201-207

Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy

  • A. C. G. BreezeAffiliated withDivision of Maternal–Fetal Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust
  • , F. A. JessopAffiliated withDepartment of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust
  • , A. L. WhiteheadAffiliated withDepartment of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust
  • , P. A. K. SetAffiliated withDepartment of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust
  • , L. BermanAffiliated withDepartment of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustAddenbrooke’s Hospital
  • , G. A. HackettAffiliated withDivision of Maternal–Fetal Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust
  • , C. C. LeesAffiliated withDivision of Maternal–Fetal Medicine, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust Email author 
  • , for the Cambridge post mortem MRI Study Group

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Abstract

To determine the feasibility of percutaneous fetal organ biopsies in the context of a ‘minimally invasive’ perinatal autopsy after stillbirth and termination for abnormality is the aim of this study. We assessed successful biopsy rate and the proportion adequate for histological examination in 30 fetuses undergoing organ sampling before autopsy. The relationship between gestational age, body weight, death–biopsy interval, operator experience and successful biopsy rate was investigated. Significant findings from conventional block histology were compared with corresponding percutaneous biopsies. Of 210 organ biopsies attempted from seven target organs, 107 were obtained, of which 94 were adequate for pathological comment. The median delivery–autopsy interval was 4 (range 2–11) days. Adequate samples were obtained from the lung in 86% cases (95% CI 68, 96%), liver 76% (95% CI 56, 90%) and less frequently for the myocardium, kidney, adrenal, thymus and spleen. There was no relationship between biopsy success and time to biopsy, gestational age, body weight and user experience. No histological abnormalities found at autopsy were diagnosed from needle biopsies. Although targeted percutaneous biopsies appear feasible for some organs, fewer than 50% of all biopsies are adequate for histological examination. This technique cannot be considered to provide useful clinical information as part of a ‘minimally invasive’ perinatal autopsy.

Keywords

Fetus Congenital anomaly Autopsy Pregnancy loss Fetal death Organ biopsy Feasibility studies