The Continuing Relevance of Pathological Autopsy in the Era of Advanced Diagnostics

Dear Editor, Even with the leaps forward in diagnostic imaging, molecular testing, and clinical monitoring, the pathological autopsy still holds a vital place in medical education, quality control, and tracking disease trends. However, hospital autopsy rates have been falling worldwide in recent years, which is worrying. This decline could mean we’re missing out on crucial clinical insights and epidemiological data. The autopsy has always been the final word on clinical diagnosis, offering direct feedback that sharpens diagnostic precision and improves how we practice medicine. Autopsy studies continue to reveal major diagnostic discrepancies (10%–30%) despite advances in imaging, molecular testing, and emerging artificial intelligence (AI)-assisted diagnostics.1 While AI enhances pattern recognition, it remains dependent on data quality and premortem clinical assumptions, whereas autopsy provides a comprehensive, hypothesis-independent assessment. Technological process has altered – but not eliminated – diagnostic error, reinforcing the autopsy’s role as an objective standard for clinical audit and quality. These discrepancies are particularly instructive in specific subspecialties. In critical care, autopsy may clarify mechanisms of multi-organ failure; in cardiology, it is essential in sudden cardiac death. The “molecular autopsy” combines conventional examination with postmortem genetic sequencing in cases of sudden unexplained death, enabling the identification of inherited cardiomyopathies and channelopathies and facilitating preventive screening of surviving relatives. In neuropathology, it enables definitive diagnosis of several neurological disorders; and in oncology, autopsy detects unsuspected disease burden and treatment-related effects. Furthermore, it enables the comprehensive sampling of primary and metastatic sites, allowing the detailed evaluation of genomic heterogeneity, clonal evolution, and therapeutic resistance, thereby advancing precision oncology and targeted therapy development. Such subspecialty contributions underscore the continuing practical and academic relevance of autopsy in modern medicine. For both pathology and clinical medicine students, the autopsy provides a singular chance to connect macroscopic and microscopic observations with clinical information, thereby cultivating a more profound comprehension of disease mechanisms.2 The experiential learning afforded by autopsy examination cannot be fully replicated by virtual or simulated methods. Autopsies play a crucial role in public health surveillance and research, as demonstrated during the COVID-19 pandemic, where they clarified the key mechanisms such as microvascular thrombosis and diffuse alveolar damage.3 This underscores the autopsy’s unique value in uncovering new disease mechanisms and guiding future preventive and therapeutic strategies. Autopsy rates are declining due to reduced clinician engagement, consent concerns, cost constraints, and misconceptions about their modern relevance.4 Rates also vary across regions because of cultural, religious, legal, and medico-legal factors. In some countries, structured institutional policies help sustain autopsy programs, whereas elsewhere societal attitudes limit consent. Recognizing these contextual determinants is essential for developing locally appropriate strategies to revive autopsy practice. Minimally invasive techniques and postmortem imaging (computed tomography/magnetic resonance imaging) enhance family acceptance and provide objective documentation; however, they cannot replace conventional autopsy, as subtle conditions such as early myocarditis, microvascular thrombosis, and microscopic amyloid deposition require detailed histopathologic evaluation. A diversified strategy is needed to overcome these obstacles. Renewing interest and viability can be facilitated by improving clinician-pathologist contact, incorporating autopsy results into morbidity and mortality reviews, and implementing minimally invasive or “virtual” autopsy techniques.5 To conclude, the pathological autopsy is still a vital tool for research, education, and quality control. As the medical community continues to adopt new technologies, we must make sure that these developments enhance rather than replace the informative perspectives in pathological autopsy. Reviving autopsy practice through modernity, activism, and teaching will preserve its vital role in improving patient care and medical knowledge. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.