BMJ  2004;329:290 (31 July), doi:10.1136/bmj.329.7460.290

Letter

Fine needle aspiration of hepatic colorectal metastases

Fine needle aspiration has its place

The first 150 words of the full text of this article appear below.

EDITOR—Metcalfe et al underline the risks of fine needle aspiration cytology for hepatic colorectal metastases, but their proposed contraindication of fine needle aspiration and the possible diagnostic alternatives for liver lesions without apparent primary malignancy are not evidence based.1

Credit: JOHN BURBIDGE/SPL

In suspected metastases of unknown origin Metcalfe et al recommend that the investigations should be directed to detect the primary lesion, something clearly opposed to current guidelines for the diagnostic work up of unknown primary tumours that limit diagnostic approaches. Routine use of invasive surgery for the diagnosis of liver lesions implies a risk of procedure associated morbidity and morbidity that may be not reasonable in some patients with advanced cancer. Positron emission tomography cannot be considered the gold standard to differentiate between benign and malignant lesions as its sensitivity is not significantly different to that of fine needle aspiration.

We suspect that even Metcalfe et . . . [Full text of this article]

Álvaro Sanz, assistant professor, María L del Valle, assistant professor

Oncology Department, Hospital Clínico Universitario, Avenida de Ramón y Cajal 3, 47005 Valladolid, Spain asrubiales@wanadoo.es


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