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Autopsy Rates and Diagnosis

Carl D. Atkins, MD
JAMA. 1999;281(23):2181. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-23-jac90005.
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To the Editor: Dr Burton and colleagues1 present important new information on the correlation between clinical and autopsy diagnosis of malignancies. However, their analysis suffers due to the use of the wrong denominators, which leads to misleading conclusions. Although it is true that only 125 of the 225 patients with malignancies found at autopsy were correctly diagnosed, the appropriate denominator to measure discordance is 1105 cases since we must consider those patients correctly determined not to have malignancies. Additionally, of the 111 malignancies in the 100 patients whom the authors considered underdiagnosed, 34 were correctly diagnosed as having malignancies on clinical grounds and 24 had incidental malignancies. Only 8 malignancies were given an incorrect diagnosis. Thus, only about 45 (4%) of 1105 cases had clinically unsuspected malignancies that were not merely incidental (the authors analyzed their underdiagnosed cases by malignancy, not by patients, so the number of cases may be somewhat greater or less than 45). Apparently all 880 patients without malignancies were correctly identified as such clinically (the authors do not specifically state this). Only 8 (6%) of 133 pathologically diagnosed malignancies were assigned an incorrect histology or primary site. These data suggest to me that we have excellent modern diagnostic tools which have led to highly accurate clinical diagnoses, at least in New Orleans, La.


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