Diagnostic Contribution of Histopathology in Medicolegal Autopsy: A Denominator-Specific Systematic Review

Background/Objectives: Published estimates of histopathological examination (HPE) contribution in medicolegal autopsy use different denominators and outcome definitions. We examined what these estimates measure and their implications for practice.

Methods

PubMed, Embase, Web of Science, and Scopus were searched from inception to 31 May 2026 (PROSPERO CRD420261401909). Eligible studies reported denominator-specific HPE contribution. Cause of death (COD) provision and change were distinguished from manner change, confirmation, refinement, and targeted forensic interpretation. JBI checklists supported item-level appraisal. Findings were synthesized narratively without pooling.

Results

Twenty-one studies were included from 2287 identified records. Strict COD change was reported in 0/100 uncomplicated hanging suicides and 1/189 gross-clear medicolegal autopsies. A broad systematic-histology cohort reported histology-only COD provision in 36/428 cases. In separate unresolved-COD populations, studies reported COD provision in 49/203 and 40/71 cases. These results address different diagnostic questions and do not establish a relationship between uncertainty and yield. Selected denominators, composite outcomes, and incomplete separation from other investigations limited interpretation. Confirmation, injury assessment, and organ-specific findings represented additional functions.