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Good news for the autopsy: genomic analysis of metastatic cancer deaths
  1. Sebastian B Lucas
  1. Department of Cellular Pathology, Guy's & St Thomas' NHS Trust, London, UK
  1. Correspondence to Professor Sebastian B Lucas, Department of Cellular Pathology, Guy's & St Thomas' NHS Trust, London SE1 7EH, UK; sebastian.lucas{at}kcl.ac.uk

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Why are autopsies performed in modern Britain? The majority of coronial autopsies are commissioned because the cause of death is not known and, put simply, are required to formulate a medical certificate of cause of death, and thus to enable disposal of the body.

In 2018, in England and Wales, there were more than 85 000 coronial autopsies (16% of everyone who died). Less invasive examinations (mainly CT cadaveric scans) now comprise 4% of these autopsies—a proportion that is rising nationally—and in parts of northwest England, more than half of coronial autopsies are of this type.1 A counter to that datum (for those who believe that without lots of autopsy histology, wrong diagnoses are inevitable) is that, overall, the proportion of autopsies that include histology has risen and is now 22%.

That is the medicolegal autopsy work. What about consented autopsies, the so-called hospital–academic postmortem examination? No firm national data are available, but the guestimate is that they number no more than 1–2000 adults a year (I exclude the numerous perinatal death examinations, which have a rather different purpose). This is a massive decline in the audit of death and its causes over the 44 years during which I have been examining deaths in England.

Another datum that is not known with any precision is the proportion of deaths coming to autopsy that are due to cancer. In coronial statistics, they are placed mainly in ‘death from natural causes’, although a few will be classified under ‘accidental/misadventure’ (if there was a mishap in the healthcare system) or ‘industrial disease’ if they are asbestos-related. From personal observations, cancer is under-represented in modern autopsy work. The …

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