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What is MITS?


Minimally Invasive Tissue Sampling (MITS) is an innovative post-mortem examination approach for understanding the causes of death by providing improved health data.

MITS is carried out by trained pathologists and technicians. The process starts with collecting small amounts of tissue and fluid from key organs by inserting fine needles into the body. These samples are then analyzed for key pathogens and infectious diseases, as well as malignant tumors.

History of the MITS Approach

The concept of minimally invasive postmortems study to support cause of death determination dates back to the late 1800s in Baltimore, Maryland, where Dr. Howard Kelly described minimally invasive approaches for sampling organs as part of an autopsy. Some decades later in 1930, Décio Parreiras and Werneck Genofre used needle- based postmortem examination during a yellow fever outbreak in Brazil.

Examples of more structured needle-based postmortem examinations began to appear in research literature in the mid-twentieth century. Early studies were mostly conducted in high-income countries but starting in 2010 a growing number of studies were conducted in low- and middle-income countries (LMICs). Initial studies in LMICs were disease-specific, but as of 2015 evolved to include more expansive postmortem examination.

At the same time, validation of the MITS approach compared to complete diagnostic autopsy methods was documented across a number of observational studies and demonstrated the value of MITS in providing cause of death determination across all age groups. Additionally, the potential acceptability of the approach was being documented, especially in communities where complete diagnostic autopsies were not routinely performed.

Over the last decade the use of MITS has continued to expand, and MITS is increasingly being used for mortality surveillance purposes.

Today the utility of MITS ranges from addressing specific pathogen-specific research questions to contributing pathology-based cause of death data as part of Health Demographic Surveillance Systems.

Benefits of the MITS Approach

Complete diagnostic autopsies, considered the gold standard, are rarely done in low resource settings to determine a person's cause of death. Many health centers lack the resources and infrastructure needed to carry out the complex procedure, which can also be considered culturally unacceptable in some contexts. Verbal autopsies (VA), which are traditionally used as an alternative to full autopsies, can be inconclusive and inconsistent.

MITS is a relatively simple autopsy approach that can provide additional information to determine a more accurate and specific cause of death than might otherwise be available.

With more accurate data on mortality causes, governments and health institutions can better plan and prioritize their efforts—ultimately saving lives around the world. MITS can improve cause of death data from other less sensitive mortality surveillance methods such as verbal autopsy. When paired with verbal autopsy, MITS cases can be used as reference cases to calibrate verbal autopsy and contribute to more accurate cause of death estimates in contexts where VA is widely used.