Autopsy vis-à-vis defective preservation and dispatch: a retrospective audit of medicolegal histopathology

Abstract

Background: Histopathology can strengthen medico-legal opinions, but its yield depends on pre-analytical steps: what is sampled at autopsy, how tissue is preserved/packaged, and how it is dispatched/received. We audited these steps to quantify where the diagnostic value is lost.
Methods: We did retrospective audit of medico-legal histopathology submissions during calendar year 2022 at the Himalayan Institute of Medical Sciences (SRHU), Dehradun, Uttarakhand, India. We analysed all attempted submissions (parcels + paperwork), integrating pre-receipt intake rejections (leakage; labelling/document discrepancies) with cases received and accessioned. Defects were classified as: (i) autopsy-side sampling; (ii) preservation/dispatch; and (iii) packaging/labelling.
Results: Total 82 attempted submissions, 22/82 (26.8%; 95% CI 17.1–36.5) were returned before receipt (leakage 4/82, 4.9%; labelling/document discrepancies 18/82, 22.0%). The laboratory received 60/82 (73.2%); among these, 32/60 (53.3%) were diagnostic/informative and 28/60 (46.7%) were non-diagnostic. Within received cases, preservation/dispatch defects were present in 30/60 (50.0%; 37.3–62.7), autopsy-side sampling defects in 7/60 (11.7%; 3.5–19.8), and packaging/labelling defects in 2/60 (3.3%; 0.0–7.9). Viewed end-to-end, only 32/82 (39.0%; 28.3–49.7) attempts yielded a diagnostic report; 28/82 (34.1%) failed after receipt and 22/82 (26.8%) were rejected pre-receipt. Geography showed modest, imprecise differences (preservation/dispatch: hills 36.4% vs plains 53.1%). By IPC group (received cases), preservation/dispatch defects were most frequent in 306 (71.4%) and 302 (58.3%), and lowest in 304B (14.3%). Sentinel issues included “LAD/LCx not submitted” (n=7) and single-jar multi-organ (n=2).
Conclusions: Most diagnostic loss arises after sampling but before processing, dominated by preservation/dispatch failures; a smaller, fully preventable share reflects autopsy-side omissions. A focused bundle—send the whole heart intact, ensure ≥10:1 fixative:tissue in separate jars, UN3373-style triple packaging with leak-testing and two-person label checks, plus intake triage with rapid re-submission—should improve yield and reduce avoidable loss of evidentiary value.