Zaitoun A M, Fernandez C
Department of Histopathology, Mayday University Hospital, Surrey, United Kingdom.
Pathology. 1998 May;30(2):100-4. doi: 10.1080/00313029800169036.
The aims of this study were to compare the clinical with autopsy diagnoses, to evaluate the role of histological examination in the pathological diagnoses and to assess the new pathological diagnoses uncovered by autopsy. We aimed to obtain quantitative assessment of the sensitivity, specificity and accuracy of clinical diagnoses. The guidelines for postmortem reports by the Royal College of Pathologists (1993) were implemented for reports used in this study. These guidelines are similar in intent to those of the College of American Pathologists. Complete macroscopic and histological studies of 108 (53 females) autopsies were analysed. The mean age was 78.0+/-9.0 (SD) years (range 54-94 years). The interquartile range (25%ile 75%ile) was 72-84 years, with a median of 79.5 years. Seventy per cent of all causes of death were confirmed by macroscopical and histological examination. Sixty-one clinical diagnoses were inconsistent with the pathological findings. Histological examination contributed significantly to the final diagnosis in major (5%) and minor (6%) clinicopathological as well as new pathological findings (23%). The most common causes of death not suspected clinically were pulmonary embolism (23%), bronchopneumonia (22%), ischemic heart disease (13%) and malignancies (10%). The clinical sensitivity of antemortem diagnoses was 25% for peritonitis and 24% for pulmonary embolism. The overall clinical sensitivity was 54% and specificity 92%. The accuracy of positive diagnosis was 69% and accuracy of negative diagnosis 88%. Unexpected causes of death represented a third of all causes of death reported. Histological examination is an important tool in hospital autopsy audit. A quantitative approach can be used to assess the accuracy of postmortem clinical diagnoses, to identify the possible source of clinical diagnostic weakness, and provide data that may be of use for diagnostic precision in the more difficult clinical subjects.
本研究的目的是比较临床诊断与尸检诊断，评估组织学检查在病理诊断中的作用，并评估尸检发现的新病理诊断。我们旨在对临床诊断的敏感性、特异性和准确性进行定量评估。本研究使用的报告采用了皇家病理学家学院（1993年）的尸检报告指南。这些指南的意图与美国病理学家学院的指南相似。对108例（53例女性）尸检的完整大体和组织学研究进行了分析。平均年龄为78.0±9.0（标准差）岁（范围54 - 94岁）。四分位间距（第25百分位数 - 第75百分位数）为72 - 84岁，中位数为79.5岁。所有死因的70%通过大体和组织学检查得到证实。61例临床诊断与病理结果不一致。组织学检查对主要（5%）和次要（6%）临床病理以及新病理发现（23%）的最终诊断有显著贡献。临床上未怀疑的最常见死因是肺栓塞（23%）、支气管肺炎（22%）、缺血性心脏病（13%）和恶性肿瘤（10%）。生前诊断的临床敏感性对于腹膜炎为25%，对于肺栓塞为24%。总体临床敏感性为54%，特异性为92%。阳性诊断的准确性为69%，阴性诊断的准确性为88%。意外死因占报告的所有死因的三分之一。组织学检查是医院尸检审核中的一项重要工具。定量方法可用于评估尸检临床诊断的准确性，识别临床诊断薄弱的可能来源，并提供可能有助于更困难临床病例诊断准确性的数据。
