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: firstname.lastname@example.org
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(unpublished data).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Tai et al (unpublished data).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.
Become a CHEST member and receive a FREE subscription as a benefit of membership.
Individuals can purchase this article on ScienceDirect.
Individuals can purchase a subscription to the journal.
Individuals can purchase a subscription to the journal or buy individual articles.
Learn more about membership or Purchase a Full Subscription.
Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 1
Customize your page view by dragging & repositioning the boxes below.
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.