In an accompanying article for the Fellow’s Corner we had stated that one has to perform 7 FNA passes on pancreatic masses.5 But the corresponding author has quoted this incorrectly and out of context. The statement in correct context was “One has to perform at least 7 passes on pancreatic masses to exceed a diagnostic sensitivity of 90% when onsite cytopathology service is not available.” This is not true when a pathologist Selleckchem GSK-3 inhibitor is available to render onsite diagnosis. A major (theoretical) advantage of the biopsy needle is the ability to render (definitive) diagnosis
with just one pass or a few passes because the technique is not dependent on onsite cytopathology. Our study proves otherwise. If only a single pass were to be performed, then a diagnosis learn more cannot be established in one-third of patients. In our experience, the ProCore needle provides excellent samples, but, as with a standard FNA needle, one requires to make at least 3 passes to reach >90% diagnostic accuracy. At academic institutions, we attempt to do the best studies we can, and we enjoy working with industry on research and development. As my mentor Peter Cotton had quoted, “Randomization is not the (only) answer.”6 But, despite limitations, randomized trials are more solid in design and the findings more valid than when random side-by-side comparisons are performed with poor definitions and
outcome measures. When there is a stylet dysfunction and a new needle
has to be used, it is “needle dysfunction,” “period.” This cannot be ignored or discounted, as the corresponding author has suggested. One needs to report the truth and let the readers judge the findings. The following author disclosed a financial relationship relevant to this publication: S. Varadarajulu is a consultant for Boston Scientific Corporation. All other authors disclosed no financial relationships relevant to this publication. “
“We Niclosamide read with interest the article by Bartels et al1 describing a higher lymph node yield at surgery associated with preoperative colonoscopic tattooing for colorectal cancer. It is possible that tattooing may also help with the identification of peritoneal disease. We previously described a case wherein carbon pigment was seen in peritoneal adenocarcinoma deposits after preoperative tattooing of a rectal cancer.2 After neoadjuvant chemotherapy, the visually striking black deposits were seen at surgery on the rectosigmoid mesentery and adjacent to the cecal pole, without other areas of carbon staining in the peritoneum identified. The carbon pigment was confirmed at histopathology within the carcinomatous deposits, both free and within macrophages. The mechanism by which this occurred is unclear; of note, a saline solution preinjection technique was not used in our case.