EC Pulmonology and Respiratory Medicine

Due to the great advances in diagnostics (imaging, molecular, genetic, etc.) and the drastic decline in autopsies (lack of confrontation), one might think that pathological examinations (at least in diseases of autoimmune, musculoskeletal, metabolic origin, etc.) are no longer necessary. Diseases change over time, partly due to treatment and partly due to other reasons (environmental, genetic etc.). Clinical symptoms can be misleading. Complications of the underlying disease and/or comorbidities can influence each other, classic clinical symptoms can change, and fatal complications of the underlying disease or important comorbidities may remain unrecognized. Pathology should be considered according to its value. Pathological findings or diagnoses are data that clinicians must compile together with other findings as part of the patient’s medical history, clinical picture, course of illness, etc. It is the clinician’s responsibility to evaluate the pathological finding or diagnosis according to its significance (taking into account the pathologist’s professional experience, of course). Institutions dealing with general diseases (including autoimmune, musculoskeletal, cardiorespiratory, gastrointestinal etc. diseases) are confirmed with basic diagnostic tests, including general pathology procedures. Accurate knowledge of each other’s strengths and weaknesses and the use of common terminology are obvious requirements for proper patient care. I would like to emphasize the decisive role of pathology by presenting some examples of diagnostic pitfalls in this short comment, highlighting the diagnostic value of an autopsy and histological examinations. Until the end of the 20th century all patients who died in a hospital in Hungary were autopsied. Between 1970 and 2000, 11537 patients died at the National Institute of Rheumatology; of these, 234 patients had rheumatoid arthritis (RA), and all of them were autopsied.

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