Feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients
Feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients
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DOI：
10.1007/s00261-020-02753-7
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发表时间：
2020-09-17
影响因子：
2.4
通讯作者：
Hecht, Jonathan L.
中科院分区：
文献类型：
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作者：
Brook, Olga R.;Piper, Kimberly G.;Hecht, Jonathan L.
目的 确定超声引导下对 COVID-19 患者进行微创尸检的可行性和安全性。方法 根据研究人员的情况，考虑将 60 名在 2020 年 4 月 22 日至 2020 年 6 月 5 日之间因 COVID-19 死亡的患者纳入研究。通过 13G 同轴针对 14G 核心活检进行微创超声引导尸检。该方案需要 20 个肝脏核心、30 个肺核心、12 个脾脏核心、20 个心脏核心、20 个肾脏核心、4 个乳房核心、4 个睾丸核心、2 个骨骼肌核心和 4 个脂肪核心，每个患者总共 112 个核心。通过数量、大小、组织学、免疫组织化学和原位杂交（COVID-19）和 PCR 测量的 SARS-CoV-2 病毒载量来评估样本质量。结果 纳入 5 名患者（5/60，8%）。所有接触过的家属都同意进行微创尸检。除了 2 名患者因肾脏萎缩而未获取肾脏样本外，所有活检器官均在超声引导下成功定位，获得了所有所需样本。组织核心的数量、大小和重量均符合课题组的预期，组织学质量优良。病理学结果与之前报道的 COVID-19 尸检结果一致。在肺、肝脏和脾脏中检测到最高的 SARS-CoV-2 病毒载量，其中少量到中等数量，在心脏中检测到较低的病毒载量，占 2/5 (40%)。肾脏中未检测到病毒（0/3，0%）。结论 超声引导下经皮死后核心活检可以安全地提供足够的组织。肺部的 SARS-CoV-2 病毒载量最高，其次是肝脏和脾脏，心肌中也有少量病毒。
Objectives To determine the feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients. Methods 60 patients who expired between 04/22/2020-05/06/2020 due to COVID-19 were considered for inclusion in the study, based on availability of study staff. Minimally invasive ultrasound-guided autopsy was performed with 14G core biopsies through a 13G coaxial needle. The protocol required 20 cores of the liver, 30 of lung, 12 of spleen, 20 of heart, 20 of kidney, 4 of breast, 4 of testis, 2 of skeletal muscle, and 4 of fat with total of 112 cores per patient. Quality of the samples was evaluated by number, size, histology, immunohistochemistry, and in situ hybridization for COVID-19 and PCR-measured viral loads for SARS-CoV-2. Results Five (5/60, 8%) patients were included. All approached families gave their consent for the minimally invasive autopsy. All organs for biopsy were successfully targeted with ultrasound guidance obtaining all required samples, apart from 2 patients where renal samples were not obtained due to atrophic kidneys. The number, size, and weight of the tissue cores met expectation of the research group and tissue histology quality was excellent. Pathology findings were concordant with previously reported autopsy findings for COVID-19. Highest SARS-CoV-2 viral load was detected in the lung, liver, and spleen that had small to moderate amount, and low viral load in was detected in the heart in 2/5 (40%). No virus was detected in the kidney (0/3, 0%). Conclusions Ultrasound-guided percutaneous post-mortem core biopsies can safely provide adequate tissue. Highest SARS-CoV-2 viral load was seen in the lung, followed by liver and spleen with small amount in the myocardium.