Feasibility and safety of ultrasound-guided minimally invasive autopsy in COVID-19 patients
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INTERVENTIONAL RADIOLOGY
Feasibility and safety of ultrasound‑guided minimally invasive autopsy in COVID‑19 patients Olga R. Brook1 · Kimberly G. Piper2 · Noe B. Mercado3 · Makda S. Gebre3 · Dan H. Barouch3 · Kathleen Busman‑Sahay4 · Carly E. Starke4 · Jacob D. Estes4 · Amanda J. Martinot3,5 · Linda Wrijil5 · Sarah Ducat5 · Jonathan L. Hecht6 Received: 24 July 2020 / Revised: 30 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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 SARSCoV-2 viral load was seen in the lung, followed by liver and spleen with small amount in the myocardium. Keywords Autopsy · Biopsy · COVID-19 Abbreviations COVID-19 Coronavirus 19 PCR Polymerase chain reaction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00261-020-02753-7) contains supplementary material, which is available to authorized users. * Olga R. Brook [email protected] 1
Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA
2
Department of Vascular Surgery, Beth Israel Deaconess Medical Center, Boston, USA
3
Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 IRB Institutional Review Board HIPAA Health Insurance Portability
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