The Clinical, Research, and Social Value of
Autopsy After Any Cancer Death
A Perspective From the Children’s Oncology Group Soft Tissue Sarcoma Committee
Sheri L. Spunt, MD1; Sara O. Vargas, MD2; Cheryl M. Coffin, MD3; Stephen X. Skapek, MD4; David M. Parham, MD5;
Joan Darling, PhD6; Douglas S. Hawkins, MD7; and Charles Keller, MD8
Recent cancer research efforts have focused on better understanding tumor biology to facilitate the development of
cancer,1chronic myeloid leukemia,2and neuroblastoma,3have resulted directly from tumor biology studies followed by
targeted drug development. However, progress is limited when sufficient tumor tissue is not available for study. Here, we
review themedical,scientific,and socialbenefits offeredby autopsythatincludes tumortissue harvestingafter thedeathof
cancer patients (Table 1). Although largely overlooked as a source of research data, the autopsy has become increasingly
important to the advancement of cancer biology studies and the development of targeted therapies. Our hope is to pro-
mote a strong initiative among practicing oncologists to seek autopsy consent for both diagnostic purposes and research
tissue acquisition. Optimizing collection of tumor specimens would facilitate the development of novel therapies for
Research Benefits of Postmortem Versus Antemortem Tumor Specimens
Tumor tissue obtained from living patients often is suboptimal for research needs. Some tumors, particularly small, clini-
cally benign-appearing lesions, may be excised in settings in which they are not preserved in a manner appropriate for
research. Even at centers with cancer expertise, tumor specimens taken at the time of initial diagnosis may be extremely
small, especially when obtained by needle-core biopsy or by a small incision. Advancing technologies in interventional ra-
diology and video-assisted endoscopy also have reduced the size of biopsy specimens, commonly providing only enough
tissue to establish the diagnosis and leaving none for special study. Furthermore, these specimens may not include the
most biologically aggressive region of the tumor. The finding that tumors can be genetically heterogeneous has been
increasingly appreciated. For example, it is now well known that v-myc myelocytomatosis viral-related oncogene, neuro-
blastoma derived (NMYC) gene amplification can be restricted to certain areas of neuroblastoma.4Intratumor karyotypic
heterogeneity has been documented in various cancers, including carcinomas and soft tissue sarcomas.5,6When tumors
recur, the small size of the biopsy sample (if obtained) again often precludes research use or limits the research-related
assaysthatcan be performed.
In contrast, patients often have a very large tumor burden at the time of death. A larger quantity of tumor tissue can
be collected after death and preserved by different methods to support a variety of analyses. Examples include collection of
DOI: 10.1002/cncr.26620, Received: June 20, 2011; Revised: August 21, 2011; Accepted: September 13, 2011, Published online October 17, 2011 in Wiley
Online Library (wileyonlinelibrary.com)
We gratefully acknowledge ongoing technical and administrative assistance by Natalie Beeler, Julie Moore, Laura Monovich, and others at the Biopathology Center who
supportthe Children’s Oncology Group Soft Tissue Sarcoma Biology and Tissue Banking Study. We also thank Sharon Naron, MPA, ELS, for editingthe article.
Corresponding author: Sheri L. Spunt, MD, Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, S6011, Memphis, TN
38105-3678; Fax: (901) 595-5845; email@example.com
1Department of Oncology, St. Jude Children’s Research Hospital and Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennes-
see;2Department of Pathology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts;3Department of Pathology, Vanderbilt University,
Nashville, Tennessee;4Department of Pediatrics, University of Chicago, Chicago, Illinois;5Department of Pathology, University of Oklahoma Health Sciences Cen-
ter, Oklahoma City, Oklahoma;6Children’s Oncology Group—Patient Advocacy, Lincoln, Nebraska;7Division of Hematology/Oncology, Seattle Children’s Hospital,
Seattle, Washington;8Pediatric Cancer Biology Program, Pape’ Family Pediatric Research Institute, Department of Pediatrics, Oregon Health & Science University,
June 15, 2012
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Autopsy in Cancer Patients/Spunt et al
June 15, 2012