BMJ  2004;329:1045-1046 (30 October), doi:10.1136/bmj.329.7473.1045-c

Letter

Biopsy of potentially operable hepatic colorectal metastases is not useless but dangerous

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

EDITOR—We have followed with interest the debate about tumour seeding in the aftermath of fine needle aspiration cytology (FNAC) in patients with potentially resectable hepatic colorectal liver metastases.1 The verdict of Metcalfe et al of "useless and dangerous" seems to have provoked strong emotions among some of your readers, and we should like to contribute two observations.

Our staging protocol comprises liver specific magnetic resonance imaging, chest tomography, and the selective use of positron emission tomography, laparoscopy, or a "trial of time," but excluding biopsy. Since 1986 we have undertaken more than 1000 liver resections for metastatic cancer without resort to preoperative biopsy or FNAC, with only seven false positives. In two patients, hepatic cysts were diagnosed at operation and resection was deferred, whereas liver resection was undertaken without complication in the other five (three haemangiomas and two cysts).

A recent analysis of 598 consecutive patients undergoing radical . . . [Full text of this article]

Oliver M Jones, specialist registrar in surgery

North Hampshire Hospital, Basingstoke RG24 9NA

Myrddin Rees, consultant hepatobiliary surgeon

myrddinrees@btconnect.com, North Hampshire Hospital, Basingstoke RG24 9NA

Tim G John, consultant hepatobiliary surgeon, Sean Bygrave, statistician, Graham Plant, consultant interventional radiologist

North Hampshire Hospital, Basingstoke RG24 9NA


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Relevant Article

Useless and dangerous—fine needle aspiration of hepatic colorectal metastases
M S Metcalfe, F H G Bridgewater, E J Mullin, and G J Maddern
BMJ 2004 328: 507-508. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

  • Garden, O J, Rees, M, Poston, G J, Mirza, D, Saunders, M, Ledermann, J, Primrose, J N, Parks, R W (2006). Guidelines for resection of colorectal cancer liver metastases. Gut 55: iii1-iii8 [Full text]  
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