Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America.
Department of Pathology, University of Massachusetts School of Medicine, Worcester, MA, United States of America.
PLoS One. 2021 Aug 11;16(8):e0255917. doi: 10.1371/journal.pone.0255917. eCollection 2021.
Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis.
We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival.
We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3-17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240).
The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.
肺肿瘤栓塞（PTE）在死亡前难以检测，并且尚不清楚诊断技术的进步是否会改善生前临床和死后诊断之间的差异。在这项研究中，我们确定了 PTE 的发生率，并分析了生前临床和死后诊断之间的差异。
我们对 1990 年至 2020 年患有恶性实体瘤病史的患者进行了回顾性尸检研究，并回顾了所有患有 PTE 的患者的切片。我们还使用 Goldman 标准分析了 1999 年、2009 年和 2019 年的生前临床和死后诊断之间的差异。 Goldman 类别主要 1 是指尸检诊断为直接死因且未被临床识别的病例，但如果被识别，可能会改变治疗或延长生存。
我们在 658 例患有实体恶性肿瘤的尸检病例中发现了 20 例（3%）PTE 病例。在这 20 例中，尿路上皮癌（30%，6/20）和乳腺浸润性导管癌（4/20，20%）是最常见的原发性恶性肿瘤。7 例有呼吸困难的患者在症状出现后 3-17 天（平均 8.4±2.2 天）内死亡。20 例患者中有 7 例（35%，7/20）生前临床怀疑肺栓塞，但只有 2 例（10%，2/20）在生前通过影像学检查诊断。1999 年 Goldman 类别主要 1 的发生率为 13.2%（10/76），2009 年为 7.3%（4/55），2019 年为 6.9%（8/116）。尽管 Goldman 类别主要 1 的发生率似乎在下降，但差异无统计学意义。2019 年尸检率（8.4%，116/1386）明显高于 2009 年（4.4%，55/1240）。
PTE 的发生率并不常见。尽管放射技术有所进步，但放射影像学检查并未发现大多数 PTE。过去 30 年来，生前临床和死后诊断之间的差异并没有显著改善，这强调了尸检的价值。
