Pulmonary tumor embolism: A retrospective study over a 30-year period.

<h4>Background</h4>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...

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Autores principales:	Xin He, Douglas C Anthony, Zulmira Catoni, Weibiao Cao
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5d903cdc903a4c5b852f204064e42669
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spelling	oai:doaj.org-article:5d903cdc903a4c5b852f204064e426692021-12-02T20:18:21ZPulmonary tumor embolism: A retrospective study over a 30-year period.1932-620310.1371/journal.pone.0255917https://doaj.org/article/5d903cdc903a4c5b852f204064e426692021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255917https://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.Xin HeDouglas C AnthonyZulmira CatoniWeibiao CaoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255917 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Xin He Douglas C Anthony Zulmira Catoni Weibiao Cao Pulmonary tumor embolism: A retrospective study over a 30-year period.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.
format	article
author	Xin He Douglas C Anthony Zulmira Catoni Weibiao Cao
author_facet	Xin He Douglas C Anthony Zulmira Catoni Weibiao Cao
author_sort	Xin He
title	Pulmonary tumor embolism: A retrospective study over a 30-year period.
title_short	Pulmonary tumor embolism: A retrospective study over a 30-year period.
title_full	Pulmonary tumor embolism: A retrospective study over a 30-year period.
title_fullStr	Pulmonary tumor embolism: A retrospective study over a 30-year period.
title_full_unstemmed	Pulmonary tumor embolism: A retrospective study over a 30-year period.
title_sort	pulmonary tumor embolism: a retrospective study over a 30-year period.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/5d903cdc903a4c5b852f204064e42669
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Pulmonary tumor embolism: A retrospective study over a 30-year period.

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