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Published On May 27, 2020

POLICY

The Autopsy Ascendant

The traditional post-mortem undergoes a reinvention.

Nationwide, the practice of the hospital autopsy is at historic lows, performed on fewer than one in 20 patients. The procedure is most frequently performed when a death is related to a crime or is otherwise suspicious, and in many cases those are performed by medical examiners, who are sometimes but not always physicians. A growing number of academic institutions, however, are trying to bring the procedure back into the fold to fulfill one of its core historic roles—as a source of discovery.

The resurgence owes a lot to a model called the rapid research autopsy. In this approach, normal and diseased tissue samples are obtained within hours of a patient’s death, rather than the 12 to 48 hours for a traditional autopsy. Pathologists, oncologists and technicians work together to extract targeted, predetermined samples of tissue. These can be immediately cultured to create living cell lines, preserved in liquid nitrogen or in paraffin blocks or, in some cases, implanted in animal models.

This approach has been especially helpful in studying cancer. Researchers can sample large volumes of tissue from different areas of the body, gaining clues about how a cancer changes as it spreads. “We can’t do all the science we need on a small biopsy,” says Jody Hooper, a physician who runs the rapid research autopsy program at Johns Hopkins Medicine. “The rapid autopsy gives us the opportunity to compare different sites and different time points of a tumor.”

Hooper wrote an article in Cancer that outlined recent insights from rapid autopsies. Different studies have looked at a range of cancer types and helped researchers trace the origins of a particular case from an initial founder cell to the development of metastases, showing exactly where and sometimes how resistance to a treatment takes hold.

James Stone, a physician who heads autopsy services at Massachusetts General Hospital, notes that the approach can have very practical applications. A team from Mass General Cancer Center recently used the process to identify, for the first time, specific genetic mutations that contributed to resistance to a promising group of targeted cancer drugs.

Autopsies have also stepped up in another way in 2020: Stone is currently performing them on those who have died from COVID-19. His lab is providing these COVID-19 infected tissues to laboratories throughout the Boston area, where some of the most concentrated research on the pandemic is located. “They are going to be vital for understanding the complications of the virus,” says Stone. Laboratories around the world are piecing together how the disease progresses in the body and what systems—the gut, kidneys, heart and brain—it affects. “Core to this will be the lessons that these patients who succumb to COVID-19 can teach us,” he says.