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(Chest. 2002;121:309.)
© 2002 American College of Chest Physicians

Discrepancies Between Clinical and Autopsy Diagnoses in Cases of Malignant Neoplasm

Ken-ichiro Inoue, MD and Toshikazu Yoshikawa, MD, PhD

Department of Internal Medicine Naka Central Hospital Ibaraki, Japan First Department of Internal Medicine Kyoto Prefectural University of Medicine Kyoto, Japan

Correspondence to: Ken-ichiro Inoue, MD, Department of Internal Medicine, Naka Central Hospital, 1733-1 Iida, Naka-cho, Naka-gun, Ibaraki-Prefecture, 311-0134, Japan; e-mail: keni{at}kk.iij4u.or.jp

To the Editor:

We read with interest the retrospective autopsy report review of cases from a medical ICU by Tai et al (February 2001).1 However, in regard to undiagnosed malignancies in autopsy-confirmed cases, we consider that it is difficult to accept their data from several points: 10 days of hospitalization seemed a short time to diagnose malignant tumors; Tai et al did not describe the diagnostic procedure in detail; and the patients who participated in their study appeared to be younger than average for malignancies. Thus, to investigate discrepancies between clinical diagnoses and autopsy findings in malignancies, the data of hospitals treating patients of various ages, and with not only emergent diseases but also chronic ones, may be more reliable.

We previously reviewed 445 consecutive malignancies diagnosed by postmortem examination from 1988 to 1997 to elucidate discrepancies between clinical diagnoses and autopsy findings.2 Our rate of undiagnosed malignancies was 11.2% (50 of 445). These malignancies included 16 thyroid cancers, 10 prostate cancers, and 10 colon cancers (unpublished data). These undiagnosed malignancies consisted of 46 class-2 errors and 4 class-1 errors according to the review criteria by Tai et al (unpublished data). In the hospital we review, in cases of suspected malignancy, a systemic medical workup including chest and abdominal radiographs or ultrasonography is generally performed. Many of the patients present with a relatively high performance status, and complete medical workups can be carried out over a 2-week period or longer. In conclusion, we want to emphasize the importance of autopsy, because > 10% of malignant neoplasms remain undiagnosed despite advances in medical technology.

References

  1. Tai, DYH, El-Bilbeisi, H, Tewari, S, et al (2001) A study of consecutive autopsies in a medical ICU: a comparison of clinical cause of death and autopsy diagnosis. Chest 119,530-536[Abstract/Free Full Text]
  2. Inoue, K, Yoshioka, K, Kawahito, Y (1999) Is the discordance rate of malignancy still high [letter]? Arch Intern Med 159,1013[Free Full Text]




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