In Reply: In response to Dr Pickhardt and colleagues, in our flat lesion study we used standard terminology (the Japanese Society for Cancer of the Colon and Rectum1) that is used in other clinical studies. In a previous publication,2 Pickhardt et al used the same definition of flat lesion: “a shallow plaquelike broad-based lesion with a height of less than one half of its width.” Although “flat” colorectal neoplasms may be slightly elevated compared with the normal mucosa, their detection during high-resolution colonoscopy relies on color change, absence of vascularity, wall defect, and friability.
Soetikno RM, Kaltenbach T, Rouse RV. Screening for Nonpolypoid Colorectal Neoplasms—Reply. JAMA. 2008;299(23):2743-2744. doi:10.1001/jama.299.23.2743-b