IMPLANTATION METASTASES FROM GASTROINTESTINAL CANCER AFTER PERCUTANEOUS PUNCTURE OR BILIARY DRAINAGE

Objective: Evaluation of incidence and outcome of implantation metasta ses after percutaneous fine-needle biopsy or biliary drainage. Design: Retrospective study. Setting: University hospital, Sweden. Subjects: Eight patients with implantation metastases from gastrointestinal canc ers after percutaneous fine-needle biopsy (n = 7) or biliary drainage (n = 1). Main outcome measures: Incidence of implantation metastases, treatment and influence on outcome and survival. Results: In two out o f three patients who had had otherwise radical operations, the implant ation metastases meant that the operations were palliative rather than curative. Patients who had had palliative resections of the implantat ion metastases developed major local complications. One patient is ali ve with no signs of disease after 106 months, while one is alive with disease 30 months after the diagnosis of the implantation metastases. The remaining patients have died after 6 to 23 months. Conclusion: The incidence of implantation metastases after fine-needle procedures is probably underestimated. There is a slight but definite risk that the procedure may render an otherwise curative resection palliative. Impla ntation metastases cause local complaints of varying severity and seem s to have a tendency to recur locally. We recommend that fine-needle b iopsy should be restricted to patients who will truly benefit from a m ore accurate preoperative diagnosis.