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Risk of seeding is reduced by associating diagnostic biopsy with percutaneous ablation for hepatocellular carcinoma
  1. G Germani,
  2. M Pleguezuelo,
  3. R Stigliano,
  4. A K Burroughs
  1. The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
  1. Professor A K Burroughs, The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Pond Street, London NW3 2QG, UK; andrew.burroughs{at}royalfree.nhs.uk

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We believe that the review and meta-analysis by Silva et al (Gut 2008;57:1592–6) on needle tract seeding following diagnostic needle biopsy of suspicious liver lesions lacks some important information and a conclusion. They evaluated cross-sectional case studies and historical case controlled studies but not studies on seeding following ablative therapies (percutaneous ethanol injection and radio-frequency ablation (RFA)). They only identified eight articles for the systematic review with a total number of 1340 patients with hepatocellular carcinoma (HCC). However, in our previously published review,1 using similar search criteria, we found 14 such studies (in which the size of the cohort biopsied was known) with 2242 patients, and 25 other series either without a denominator, or case reports, both of which …

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