Is postmortem examination useful in pediatric oncology?

Clinicians are often reluctant to request an autopsy for patients who have been extensively investigated during life, because they may believe that little additional information will be obtained. To examine whether this is the case, the autopsy records of pediatric oncology patients at the Adelaide Children's Hospital were reviewed. A total of 63 oncology patients died in the hospital during the period 1982-1991, 28 of whom underwent postmortem examination. Class I findings (those that would have altered management if they had been known during life) were found in 7 cases (25%). Major pathological findings that would not have altered management (class II) were found in 14.3% of cases. The most common class I findings were fungal infections with organisms such as Aspergillus or Candida species. Postmortem examination also revealed treatment-related complications in five patients, and in one case the diagnosis was made only at autopsy. This study confirms that postmortem examination can provide valuable new information even for patients who had been widely investigated in life and in whom the cause of death may appear obvious.