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Clinical Review Lesson of the week

Useless and dangerous—fine needle aspiration of hepatic colorectal metastases

BMJ 2004; 328 doi: (Published 26 February 2004) Cite this as: BMJ 2004;328:507
  1. M S Metcalfe, visiting surgeon1,
  2. F H G Bridgewater, consultant surgeon1,
  3. E J Mullin, research registrar1,
  4. G J Maddern, professor of surgery (
  1. 1University of Adelaide Department of Surgery, Queen Elizabeth Hospital, Woodville, SA 5011, Australia
  1. Correspondence to: G J Maddern


    Fine needle aspiration cytology (FNAC) is an established tool for diagnosing liver tumours. It has recognised complications, however. Use of the procedure in abdominal tumours is fatal in 0.006 to 0.031% of cases.1 2 Most deaths occur with liver tumours and are due to haemorrhage. Another complication is that metastases can seed along biopsy needle tracts, although this has been reported to be rare, with an incidence of 0.003% to 0.07%, mostly from pancreatic tumours.1 2 More recently, much higher rates (0.4% to 5.1%) of needle tract metastases have been reported when FNAC is used in liver lesions, usually for primary liver tumours.37

    Only 13 cases of needle tract colorectal metastases caused by FNAC in liver lesions are described in journals listed in Medline.713 Several authors have commented that the procedure should be avoided because of the risk of this complication. A further similar case is reported here, extending the contraindication of FNAC in hepatic tumours to include lesions for which no primary malignancy has been found. Therefore in Western populations, in which primary liver malignancy is rare, the diagnosis of apparently malignant liver lesions should centre on searching for the primary tumour, rather than on FNAC of the lesion.

    Case report

    A 78 year old man presenting with back pain was found on computed tomography of his abdomen to have a lesion in the right lobe of his liver. FNAC of the lesion was done without referral to a surgeon, …

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