Differentiation and proliferation related proteins in the epithelium of prophylactically removed ovaries from women with a hereditary female adnexal cancer predisposition

Sir: We have read with great interest the report by Benbow and Roberts reviewing the different techniques for limited autopsy. In this report they summarize brilliantly the main problems affecting complete autopsy (families’ and pathologists’ antipathy, religious reasons) and state the clear need for new techniques that can stem the ever decreasing number of complete autopsies, which continue to be important to obtain epidemiological data and to improve the quality of medical care. These authors consider that partial autopsies have not been adequately validated against the complete autopsy and conclude that these partial or less invasive techniques could eventually prevail despite this insufficient validation, due in part to the antipathy towards the complete autopsy. In a recent report, kindly commented on in Benbow and Roberts’ paper, our group reported the results of a comparative study of complete autopsy and a new autopsy technique we have developed and called echopsy or ultrasonographic autopsy. In short, this technique obtains specimens for histological, cytological and other microbiological and morphological analysis from the different organs and lesions under ultrasonographic control. Further details regarding the technique have been reported elsewhere. Since this first report we have continued performing this new partial autopsy technique, but only in the hospital setting, for coroner’s autopsies are performed in Spain by specialists in forensic medicine. After performing 300 echopsies followed by complete autopsies, we have improved our original results to reach a concordance rate of 83% between the two techniques for the main diagnoses. Correlation is excellent for all the organs and systems; our worst results are obtained for diseases of the gastrointestinal tract, but these are estimated to cause only 14% of deaths and should therefore have little influence on the global accuracy of the technique. Moreover, we have recently started to use an automatic instrument for sample taking [Pro-Mag I 2,5 Automatic Biopsy instrument, Wacreees (MD-Tech, Gainesville, FL, USA)], coupled to the Tru-cut needle, that greatly simplifies and improves sampling. After validating the technique in more than 300 patients, we now perform only the ultrasonographic autopsy in selected cases. If the relatives deny permission for complete autopsy for any reason, our clinicians offer them the chance of an echopsy. Twenty-two percent of the adult autopsies performed last year in our hospital were echopsies (not followed by a complete autopsy); autopsies that would otherwise not have been performed at all. We feel our technique offers some clear advantages over some other techniques mentioned in Benbow and Roberts’ report. The first and most important one is allowing histological or cytological analysis of the lesions, since some other partial autopsy techniques (magnetic resonance, laparoscopy) only visualize the lesions, but do not include their histological analysis. The incorporation of an imaging technique overcomes the main disadvantage of needle autopsy, i.e. the ‘blind’ nature of sample taking. In summary, we certainly agree with Benbow and Roberts that the complete autopsy remains a most useful tool for medical knowledge, but we consider newer autopsy techniques employing ‘clean’ and familiar imaging techniques (like ultrasonography), that obtain adequate samples for histological analysis, deserve a justified place in Pathology and can help us to increase the number of autopsies performed in hospitals.