title: Practice of percutaneous needle autopsy; a descriptive study reporting experiences from Uganda.
abstract: BACKGROUND
  Percutaneous needle autopsy can overcome a number of barriers that limit the use of complete autopsies. We performed blind-and ultrasound guided needle autopsies in HIV-infected adults in Uganda. In this study we describe in detail the methods we used, the ability of both procedures to obtain sufficient tissue for further examination and the learning curve of the operators over time.
  
  
  METHODS
  If written informed consent was granted from the next of kin, we first performed a blind needle autopsy, puncturing brain, heart, lungs, liver, spleen and kidneys using predefined surface marking points. We then performed an ultrasound guided needle autopsy puncturing heart, liver, spleen and kidneys. The number of attempts, expected success and duration of the procedure were noted. A pathologist read the slides and indicated if the target tissue was present and of sufficient quality for pathological review. We report the predicted and true success rates, compare the yield of blind to ultrasound guided needle biopsies and evaluate the failure rate over time.
  
  
  RESULTS
  Two operators performed 96 blind needle autopsies and 95 ultrasound guided needle autopsies. For blind needle biopsies true success rates varied from 56-99% and predicted success rates from 89-99%. For ultrasound guided needle biopsies true success rates varied from 72-100% and predicted success rates from 84-98%. Ultrasound guidance led to a significantly higher success rate in heart and left kidney. A learning curve was observed over time with decreasing failure rates with increasing experience and a shorter duration of the needle autopsy.
  
  
  CONCLUSIONS
  Needle autopsy can successfully obtain tissue for further pathological review in the vast majority of cases, with a decrease in failure rate with increasing experience of the operator. The benefit of ultrasound guidance will depend on the population, the disease and organ of interest and the local circumstances. Our results justify further evaluation of needle autopsies as a method to establish a cause of death.
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium ; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Janneke A
authors.initials: JA
authors.lastname: Cox
authors.affiliation: Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Lukande
authors.affiliation: Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda ; Department of Pathology, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Sam
authors.initials: S
authors.lastname: Kalungi
authors.affiliation: Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Koen
authors.initials: K
authors.lastname: Van de Vijver
authors.affiliation: Department of Pathology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Marck
authors.affiliation: Joint Pathology Center, Silver Spring, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Nelson
authors.affiliation: Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Asafu
authors.initials: A
authors.lastname: Munema
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda ; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Yukari C
authors.initials: YC
authors.lastname: Manabe
authors.affiliation: Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerpen, Belgium ; Faculty of Medicine, University of Antwerp, Antwerp, Belgium.
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
keywords: Minimal invasive autopsy; Needle autopsy; Needle biopsy; Partial autopsy; Post mortem; Sub Saharan Africa; Tru-cut biopsy; Uganda; Ultra-sound guided biopsy