Intended for healthcare professionals

Rapid response to:

Clinical Review Lesson of the week

Useless and dangerous—fine needle aspiration of hepatic colorectal metastases

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7438.507 (Published 26 February 2004) Cite this as: BMJ 2004;328:507

Rapid Response:

Some "anecdotal" thoughts.

Dear Sir,

In 1980, a friend of mine who worked in medical research in USA, was
diagnosed, along with two of his colleagues, with early stage prostate
cancer.

We did not know this, until 1995, when there was a campaign here
advising men to get tested for prostate cancer. I discussed this with my
friend.

He said to me "If this test comes back positive, do not let them do a
fine needle aspiration."

I asked "Why?"

He said "Because when they pull the needle out, the suction created
pulls back into the body, along the exit tract, cells, .... which if
cancerous, then have direct access to the rest of the body."

I said to him "I've never read that. How do you know this?"

He replied with word to this effect "It is a matter of debate amongst
my colleagues at the moment. Some of us are extremely concerned about
this. Some say the rate of needle tract metastasis is only around 5 -
10%. I believe that figure is incorrect because it covers all fine needle
aspirations, not just those found to contain malignant cells. If you
don't have cancer cells, you won't get needle tract metastases. I believe
that the rate for those with malignant cancer cells aspirated by the
needle could be around 100%"

He then proceeded to tell me about his two colleagues whose samples
were "malignant", and how they both died very quickly from cancers that
rapidly spread through their bodies.

He chose to do it "his" way. In 1999, after a bout of the flu, he
got pain in the hip, and went to a US hospital, where they told him his
cancer had now spread. He chose hormone treatment only, refusing anything
else they had to offer. He was given three years to live.

He is still alive today.

In this debate above, there are those who say that the study
published is not scientific.

Ever since 1995, I have kept an eye on FNAC of any sort. It seems to
me that the reason there is very little "scientific" evidence as to what
the rates of secondary infection are, as a direct result of this
procedure, is because medical people have assumed that the risks
outweighed the benefits in the ABSENCE of good science.

It also seems to me, that this situation continues to this day
because those who use and advocate this procedure in their practice have
neither the interest or inclination to do proper studies to find out the
answers.

Some might ask why that would be. The answer to that question should
not be that hard to pinpoint....

Sincerely,

Hilary Butler.

Competing interests:
None declared

Competing interests: No competing interests

21 March 2004
Hilary Butler
Freelance journalist
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