Fine needle aspiration of hepatic colorectal metastases
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《英国医生杂志》
EDITOR—We are delighted to have provoked such a lively debate with our article. The only weakness anticipated in advance of publication was that it perhaps represented rather "old news." It is gratifying then to find that its message merited vigorous reiteration.
In response to the specific points of Sanz and del Valle, laparoscopic biopsy is minimally invasive and reduces the risks of both sample error and tract metastases. Positron emission spectroscopy is of similar sensitivity to fine needle aspiration cytology, we agree, and not attended by the risk of seeding metastases.
Joseph describes reducing the risk of tract metastases by modifications of technique, although no evidence is presented for this. This implies an acknowledgment of the risk itself. He seems to be arguing for risk reduction rather than elimination. We disagree. However, Joseph is quite correct to acknowledge that he may be unaware of the rate of this complication in his hands, as it is likely to present elsewhere for management. The authors look forward to Joseph publishing his series of several hundred liver biopsies through fine needle aspiration cytology with the associated complication rates. He is also correct to declare his commercial conflict of interest.
We are pleased to acknowledge responsibility for the title and thank the BMJ for allowing it to stand. Naturally, an insipid, anodyne, non-committal heading could have been concocted, perhaps in the style that one might find in some radiology or cytopathology reports, for example. However, this would seem to defeat the object of publishing a "Lesson of the week."
In response to the specific points of Sanz and del Valle, laparoscopic biopsy is minimally invasive and reduces the risks of both sample error and tract metastases. Positron emission spectroscopy is of similar sensitivity to fine needle aspiration cytology, we agree, and not attended by the risk of seeding metastases.
Joseph describes reducing the risk of tract metastases by modifications of technique, although no evidence is presented for this. This implies an acknowledgment of the risk itself. He seems to be arguing for risk reduction rather than elimination. We disagree. However, Joseph is quite correct to acknowledge that he may be unaware of the rate of this complication in his hands, as it is likely to present elsewhere for management. The authors look forward to Joseph publishing his series of several hundred liver biopsies through fine needle aspiration cytology with the associated complication rates. He is also correct to declare his commercial conflict of interest.
We are pleased to acknowledge responsibility for the title and thank the BMJ for allowing it to stand. Naturally, an insipid, anodyne, non-committal heading could have been concocted, perhaps in the style that one might find in some radiology or cytopathology reports, for example. However, this would seem to defeat the object of publishing a "Lesson of the week."