Department of Internal Medicine
Naka Central Hospital
First Department of Internal Medicine
Kyoto Prefectural University of Medicine
Correspondence to: Ken-ichiro Inoue, MD, Department of Internal Medicine, Naka Central Hospital, 1733-1 Iida, Naka-cho, Naka-gun, Ibaraki-Prefecture, 311-0134, Japan; e-mail: email@example.com
To the Editor:
We read with interest the retrospective autopsy report review of
cases from a medical ICU by Tai et al (February 2001).1
However, in regard to undiagnosed malignancies in autopsy-confirmed
cases, we consider that it is difficult to accept their data from
several points: 10 days of hospitalization seemed a short time to
diagnose malignant tumors; Tai et al did not describe the diagnostic
procedure in detail; and the patients who participated in their study
appeared to be younger than average for malignancies. Thus, to
investigate discrepancies between clinical diagnoses and autopsy
findings in malignancies, the data of hospitals treating patients of
various ages, and with not only emergent diseases but also chronic
ones, may be more reliable.
We previously reviewed 445 consecutive malignancies diagnosed by
postmortem examination from 1988 to 1997 to elucidate discrepancies
between clinical diagnoses and autopsy findings.2 Our rate
of undiagnosed malignancies was 11.2% (50 of 445). These malignancies
included 16 thyroid cancers, 10 prostate cancers, and 10 colon cancers
(unpublished data). These undiagnosed malignancies consisted of 46
class-2 errors and 4 class-1 errors according to the review criteria by
Tai et al (unpublished data). In the hospital we review, in cases of
suspected malignancy, a systemic medical workup including chest and
abdominal radiographs or ultrasonography is generally performed. Many
of the patients present with a relatively high performance status, and
complete medical workups can be carried out over a 2-week period or
longer. In conclusion, we want to emphasize the importance of autopsy,
because > 10% of malignant neoplasms remain undiagnosed despite
advances in medical technology.
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