To the Editor: In their multicenter cross-sectional study of the diagnostic accuracy of computed tomographic (CT) colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal carcinoma, Dr Regge and colleagues1 did not provide the frequency of adenomas that were nonpolypoid flat (ie, with a height of less than half of the lesion diameter) and depressed (ie, with a base that is lower than the normal mucosa) detected at colonoscopy. Such lesions are recognized with increasing frequency by skilled endoscopists in the United States,2 - 3 may compose up to about 17% of precancerous adenomas,4 and are often missed by CT colonography (with as many as 66% of flat lesions of 5-9 mm and 40% of flat lesions ≥10 mm missed4 ).
Moreover, the prevalence of flat lesions has been shown to be 2.6 times higher in a high-risk population (with personal or family history of colorectal neoplasm) compared with an average-risk population (15.4% vs 5.8%). Nonpolypoid adenomatous lesions containing carcinoma in situ or submucosal invasive carcinoma tend to be smaller in diameter than those that are polypoid.2
The failure to detect such clinically important nonpolypoid colorectal neoplasms may represent an important limitation of CT colonography as a diagnostic test, not only in patients with a history of flat neoplasia or who are at risk of flat neoplasia (such as those with inflammatory bowel disease) as suggested by Dr Finlayson in her Editorial,5 but also in the at-risk population studied by Regge et al.1 This failure requires further study.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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