Does the medical autopsy still have a place in the current diagnostic process? A 6-year retrospective study in two French University hospitals

  • Sarah Humez
  • Clémence DelteilEmail author
  • Claude Alain Maurage
  • Julia Torrents
  • Caroline Capuani
  • Lucile Tuchtan
  • Marie-Dominique Piercecchi
Original Article


Medical autopsies have been in considerable decline for several decades, in France and worldwide. We aimed to determine whether a medical autopsy still currently has a role to play in diagnosis, by analyzing its performance and diagnostic limitations. This dual-centre retrospective descriptive study included all medical autopsies performed in the university hospitals of Lille and Marseille, France, between January 2007 and December 2012. Autopsies of fetuses or stillborn infants, or those related to sudden infant deaths and research protocols were excluded. 412 medical autopsies were included. The male:female ratio was 1.5:1 and mean age was 27.3 years. Half of all autopsies were pediatric. Regarding anatomical region and/or injury mechanism, a clinical diagnosis was suggested in 52.2% of cases, an autopsy diagnosis in 55.6% and a microscopic diagnosis in 81.8%. There was very low agreement between the clinician’s suggested diagnosis and the final diagnosis, both for organ specific diseases and cause of death. Agreement was moderate between autopsy diagnoses and microscopic diagnoses for organ specific diseases and low for cause of death. From our findings we concluded that an autopsy associated with microscopic examination was still valuable in diagnosing cause of death. Microscopic examination was indispensable to determine certain causes of death.


Medical autopsy Pathology Diagnostic procedure Cause of death 


Role of author

• Sarah Humez performed the research.

• Marie-Dominique Piercecchi and Claude Alain Maurage designed the research study.

• Julia Torrents, Caroline Capuani, Lucile Tuchtan contributed essential reagents or tools.

• Sarah Humez analysed the data.

• Clémence Delteil wrote the paper.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals


Ethical approval

The approval of the ethics committee was therefore not necessary.

Informed consent

The informed consent was therefore not necessary.

This research study was however notified to the representative of the Commission on Data Processing and Freedom (CNIL in French).


  1. 1.
    Loi de bioéthique de 1994. n°94–654 juillet, 1994. Accessed 26 March 2019.
  2. 2.
    Loi de bioéthique de 2004. n°2004–800 août, 2004. Accessed 26 March 2019.
  3. 3.
    Groß D, Wilhelmy S. Clinical autopsies from a medical ethics perspective. Pathologe. 2017;38:396.CrossRefGoogle Scholar
  4. 4.
    van den Tweel JG, Wittekind C. The medical autopsy as quality assurance tool in clinical medicine: dreams and realities. Virchows Arch. 2016;468:75–81.CrossRefGoogle Scholar
  5. 5.
    Gosselin B, Gaillard D, Rambaud C. Les autopsies à l’aube de l’an 2000. Ann Pathol. 1999;19S:56–63.Google Scholar
  6. 6.
    Hauw JJ. L’Académie nationale de médecine appelle au don post-mortem de cerveau. Acad Nat Méd 2014. Accessed 26 March 2019.
  7. 7.
    Hoyert DL. The changing profile of autopsied deaths in the United States, 1972-2007. NCHS Data Brief. 2011;67:1–8.Google Scholar
  8. 8.
    Royal College of Pathologists of Australasia Autopsy Working Party. The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia. Med J Aust. 2004;180:281–5.CrossRefGoogle Scholar
  9. 9.
    Burton JL. Necropsy practice after the “organ retention scandal”: requests, performance, and tissue retention. J Clin Pathol. 2003;56:537–41.CrossRefGoogle Scholar
  10. 10.
    Chariot P, Witt K, Pautot V, et al. Declining autopsy rate in a French hospital: physician’s attitudes to the autopsy and use of autopsy material in research publications. Arch Pathol Lab Med. 2000;124:739–45.PubMedGoogle Scholar
  11. 11.
    Chatelain D, Brevet M, Guernou M, et al. Adult autopsies in a French university hospital (CHU Amiens) for the period 1975-2005. Ann Pathol. 2007;27:269–83.CrossRefGoogle Scholar
  12. 12.
    Duband S, Forest F, Dumollard JM, Chambonnière-Simon ML, Clémenson A, Péoc’h M. Les autopsies médicales : analyse rétrospective des demandes et apport de leurs résultats à la communauté hospitalo-universitaire. Ann Pathol. 2009;29:4–19.CrossRefGoogle Scholar
  13. 13.
    Sington JD, Cottrell BJ. Analysis of the sensitivity of death certificates in 440 hospital deaths: a comparison with necropsy findings. J Clin Pathol. 2002;55:499–502.CrossRefGoogle Scholar
  14. 14.
    Sonderegger-Iseli K, Burger S, Muntwyler J, Salomon F. Diagnostic errors in three medical eras: a necropsy study. Lancet. 2000;355:2027–31.CrossRefGoogle Scholar
  15. 15.
    Ornelas-Aguirre JM, Vázquez-Camacho G, Gonzalez-Lopez L, Garcia-Gonzalez A, Gamez-Nava JI. Concordance between premortem and postmortem diagnosis in the autopsy: results of a 10-year study in a tertiary care center. Ann Diagn Pathol. 2003;7:223–30.CrossRefGoogle Scholar
  16. 16.
    Bernardi FDC. Histological examination has a major impact on macroscopic necropsy diagnoses. J Clin Pathol. 2005;58:1261–4.CrossRefGoogle Scholar
  17. 17.
    Harris MD, Blundell JW. Audit of necropsies in a British district general hospital. J Clin Pathol. 1991;44:862–5.CrossRefGoogle Scholar
  18. 18.
    Loughrey MB, McCluggage WG, Toner PG. The declining autopsy rate and clinicians’ attitudes. Ulster Med J. 2000;69:83–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Goldman L, Sayson R, Robbins S, Cohn LH, Bettmann M, Weisberg M. The value of the autopsy in three medical eras. N Engl J Med. 1983;308:1000–5.CrossRefGoogle Scholar
  20. 20.
    Capuani C, Guilbeau-Frugier C, Dedouit F, Rougé D, Delisle MB, Telmon N. Implication des médecins légistes dans l’autopsie médicale : l’expérience toulousaine. Ann Pathol. 2013;33:87–92.CrossRefGoogle Scholar
  21. 21.
    Zaitoun AM, Fernandez C. The value of histological examination in the audit of hospital autopsies: a quantitative approach. Pathology (Phila). 1998;30:100–4.Google Scholar
  22. 22.
    Roulson J, Benbow EW, Hasleton PS. Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. Histopathol. 2005;47:551–9.CrossRefGoogle Scholar
  23. 23.
    Cameron HM, McGoogan E, Watson H. Necropsy: a yardstick for clinical diagnoses. Br Med J. 1980;281:985–8.CrossRefGoogle Scholar
  24. 24.
    Mosquera DA, Goldman MD. Surgical audit without autopsy: tales of the unexpected. Ann R Coll Surg Engl. 1993;75:115–7.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Shanks JH, McCluggage G, Anderson NH, Toner PG. Value of the necropsy in perioperative deaths. J Clin Pathol. 1990;43:193–5.CrossRefGoogle Scholar
  26. 26.
    Hunt CR, Benbow EW, Knox WF, McMahon RF, McWilliam LJ. Can histopathologists diagnose bronchopneumonia? Clin Pathol. 1995;48:120–3.CrossRefGoogle Scholar
  27. 27.
    Reid WA. Cost effectiveness of routine postmortem histology. J Clin Pathol. 1987;40:459–61.CrossRefGoogle Scholar
  28. 28.
    Hutchins GM. Practice guidelines for autopsy pathology. Autopsy performance. Autopsy Committee of the College of American pathologists. Arch Pathol Lab Med. 1994;118:19–25.PubMedGoogle Scholar
  29. 29.
    The Royal College of Pathologists, London. Guidelines on autopsy practice. 2002. Accessed 26 March 2019.
  30. 30.
    Blokker BM, Wagensveld IM, Weustink AC, Oosterhuis JW, Hunink MG. Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review. Eur Radiol. 2016;26:1159–79.CrossRefGoogle Scholar
  31. 31.
    Lewis C, Hutchinson J, Riddington M, Hill M, Arthurs O, Fisher J, et al. Feasibility study of minimally invasive autopsy for fetuses and children. Health Technol Assess. 2019;23:1–104.CrossRefGoogle Scholar
  32. 32.
    Latten BGH, Bakers FCH, Hofman PAM, Zur Hausen A, Kubat B. The needle in the haystack: histology of post-mortem computed tomography guided biopsies versus autopsy derived tissue. Forensic Sci Int. 2019;302:109882.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PathologyLille University HospitalLilleFrance
  2. 2.Forensic DepartmentLa Timone University HospitalMarseille Cedex 05France
  3. 3.Aix-Marseille University, CNRS, EFS, ADÈSMarseilleFrance
  4. 4.Department of Forensic PathologyMarseille Cedex 5France
  5. 5.Department of PathologyLa Timone University HospitalMarseilleFrance

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