Response to A. Matikas et al.

We thank Matikas, Foukakis, and Bergh for their insightful comments on our paper. We chose to exclude cytology papers and focused on distant metastases because we aimed to analyze maximally homogeneous studies and implemented strict inclusion and exclusion criteria to exclude factors potentially introducing heterogeneity. We absolutely agree that the fine needle aspiration biopsy (FNAB) facilitates tissue sampling of metastases, which is very much within the current diagnostic arsenal, and would like to underline that we do not state anywhere in our paper that 'FNAB of metastatic sites is not an appropriate diagnostic modality.'

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