Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy
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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.
KeywordsFetus Congenital anomaly Autopsy Pregnancy loss Fetal death Organ biopsy Feasibility studies
Members of the Cambridge post mortem MRI study group also include: Dr Justin Cross, Professor David J Lomas, and Ms Ilse Joubert (of the Department of Radiology, University of Cambridge and Addenbrooke’s Hospital). We are indebted to the parents who agreed to take part in this study at a very difficult time.
We also acknowledge the assistance of Andrew F Dean (Department of Histopathology, Addenbrooke’s Hospital), and Dr Nicholas Coleman (Hutchison-MRC Centre, Cambridge), and the paediatric pathology service staff of Addenbrooke’s Hospital: Nicola Wood, Gillian Kenyon, Simon Brown, and Michelle Macer. We also wish to thank the midwives and medical staff of the Rosie Hospital, Cambridge for their support.
This study was supported by a grant from the Trustees of the Addenbrooke’s Charities, and ACGB’s salary was supported by Cambridge Fetal Care.
Conflict of interest statement
The authors have no conflicts of interest to declare.
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